CATALOGUE AND EEPOET
OF
OBSTETRICAL AND OTHER
INSTRUMENTS
EXHIBITED AT THE CONVERSAZIONE OF THE
OBSTETRICAL SOCIETY OE LONDON,
HELD, BY PEEMISSION,
AT THE EOYAL COLLEGE OF PHYSICIANS,
Maech 28th, 1866.
LONDON :
LONGMANS, GREEN, AND CO.
1867.
PBINTED BY J. E. ADLAED, BAETUOLOMEW CLOSE.
PEEFACE.
The Exhibition of obstetrical and other instruments,
which, through the kind permission of the President and
Fellows of the Royal College of Physicians, the Obstetrical
Society of London was permitted to hold in their Library,
Avill probably form an epoch in the history of Midwifery
in this and other countries; for it is no exaggeration to
say, with the distinguished surgeon who delivered the last
Annual Address in Surgery before the British Medical
Association, that it was " one of the most astonishing
historical displays of the mechanical appliances of the ob-
stetrical branch of the Art ever collected in one room/^
The aim and purpose of this Exhibition were stated in the
Annual Address of the President, delivered in January, 1866,
in the following words :
" By bringing together the instruments that have been
used in different ages and in different countries for the
purpose of overcoming those obstetric difficulties which are
met with in all ages and all countries, we shall be able
to read by these tangible symbols the most important
chapter in the history of obstetrics; we shall be able to
enter into the thoughts of other men, our predecessors and
contemporaries, by studying the visible expressions of their
iv
PREFACE.
minds labouring in the cause of our common science ; we
shall be able to do something towards identifying and pre-
serving the original forms of instruments as they were de-
signed and used by their inventors. An instrument is not
less the offspring of a man's mind than is a book ; but the
security for preserving an instrument so that it shall, even for
a brief time, tell truly the working of the mind that produced
it_, and continue to answer, in the hands of others, the purpose
for which it was designed, is very much less than in the case
of a book. Books are at once multiplied, and copies are
deposited in libraries, where they are stored for future re-
ference ; but instruments are not struck off in numbers from
one mould : the first maker follows a model or instructions
more or less exactly ; subsequent makei's may copy the errors
and deviations from the original model, taking these errors
as essential points ; and successive practitioners may contrive
endless modifications, so that from a variety of accidents it
may, and indeed continually does happen, that the greatest
difficulty arises when we attempt to ascertain the right form
of an instrument, and to refer a particular discovery to the
rightful owner. Considerations such as these suggested to
me the idea of instituting this Exhibition.''
Invitations for contributions were accordingly sent to
distinguished professors and practitioners of obstetrics, and
to eminent instrument-makers, at home and abroad. This
appeal was responded to with such unparalleled profuseness
and liberality, as calls for the most emphatic thanks of the
Society.
The Exhibition was inaugurated on the 28th of March,
1866, by a conversazione, at which about 600 Fellows of the
Society and Visitors, including many eminent foreign phy-
sicians, were present.
The interest evinced in the Exhibition, and the desire
80 generally expressed to possess a permanent record of
PREFACE.
V
the event, have induced the Council to publish this
Catalogue in the hope that further service may thus be
rendered to obstetric medicine. The opportunity herein
afforded of comparing the several varieties of the same
instrument, and of reading the description of the modifications
adopted by various authorities in different countries in
accordance with the variations ■ in their practice, is full
of instruction to those who are anxious to perfect the art
of Obstetrics. As a work of reference, too, it is thought
that this may be of some value to those whose time and
opportunities may be too limited to allow of their becoming
fully acquainted with the best mode of, and best instrument
for, performing any given operation. The permanent utility
of such a work will be greatly facilitated if from time to
time inventors or modifiers of instruments, and instrument-
makers, British and Foreign, will send to the Editor for
insertion in future editions, descriptions, and, if possible,
illustrations, of any novelty they may have introduced.
The arrangement and classification of the instruments
herein adopted, though, perhaps, open to some objection, will
nevertheless, it is hoped, be approved by those for whose
benefit it is made. It seemed to the Editor above all things
desirable that easy reference should be the cardinal feature
in the work, and in this he trusts he has succeeded. At first
it was thought that it might be well to group together all the
instruments used in any given operation ; but the practical
difficulties of carrying this out were such as to necessitate its
abandonment, and led finally to the adoption of the one
employed.
The instruments of each kind are all grouped together in
their several varieties, and the whole is arranged in alpha-
betical order. The table of contents will show this at a
glance. In one or two instances there is a slight departure
from this plan and in favour of the one first proposed, but this
vi
PREFACE.
exception was made only on tlie ground of practical con-
venience : thuSj the instruments used in ovariotomy, in the
induction of premature labour, and for the operation of
transfusion, &c., are all grouped together, so that the inquirer
may see at a glance what are probably the best instruments
for either of those operations.
It is, perhaps, well to mention that, for the purpose for which
this Catalogue is published, it has not been thought necessary
to state that the same instrument was exhibited often by five
or six different makers. To a great extent it has been a matter
of chance whose name is mentioned as exhibiting any given
instrument, which may possibly have been shown by several
others. Nothing invidious is intended by this.
In compiling a work of this kind, which represents the
joint labours of the Committee appointed by the Council for
this purpose, it is almost impossible to avoid a few errors
either of omission or commission. It is hoped, however, that
these may neither be many nor important, and it will rest
with those who discover them to see that they are not
repeated, by their kindly taking the trouble to forward without
delay to the Editor such corrections as may be required :
due attention will be given to these in any future edition.
EDITOR.
53, Beenees Steeet, London, W.
December, 1866.
CONTENTS.
PAGE
ABDOMINAL BANDAGES, TRUSSES, &c. ... ... ... 1
ABORTION INSTRUMENTS FOR REMOVAL OF THE OVUM ... 5
ANTEVERSION, INSTRUMENTS FOR (SBE Pessaries) .. . ... 7
BANDAGES (see Abdominal Bandages, &c.) ... ... 7
BLUNT HOOKS ... ... ... ... ... 8
CAUTERISERS AND CAUSTIC HOLDERS ... ... ... 13
CEPHALOTRIBES ... ... ... ... ... 18
CHLOROFORM INHALERS, &c. ... ... ... ... 27
CRANIOCLAST ... ... ... ... ... 40
CRANIOTOMY FORCEPS ... ... ... ... 41
CROTCHETS ... ... ... ... ... 43
CURETTES... ... ... ... ... ... 44
DECAPITATORS AND SAW FORCEPS ... ... ... 46
DENTISCOPE ... ... ... ... ... 51
DILATORS... ... ... ... ... ... 52
1. Reotai ... ... ... ... ... 52
2. Ueetheai ... ... ... ... ... 53
3. Uteeinb ... ... ... ... ... 53
4. Va&inai ... ... ... ... ... 57
DOUCHES ... ... ... ... ... ... 59
ECRASEURS ... .. ... ... ... 65
ELECTRO-MAGNETIC COIL ... ... ... ... 71
ENEMA APPARATUS... ... ... ... ... 73
FEEDING BOTTLES ... ... ... ... ... 74
FORCEPS ... ... ... ... ... ... 74
1. MlDWIFEET ... ... ... ... ... 74
2. Foot FoECEPs ... ... ... ... ... 107
3. Miscellaneous ... ... ... ... 108
FORCEPS SCIE (see Decapitatoes) ... ... ... 113
F(ETUS EXTRACTORS ... ... ... ... 113
F(ETUS MEASURER ... ... ... ... ... 114
FUNIS REPLACERS ... ... ... ... ... 115
HYSTEROTOMES (see Meteotomes) ... ... ... 115
KINOMETER ... ... ... ... ... 116
LEECHES, &c. ... ... ... ... ... 116
LENICEPS (see Foeoefs, Midwifeet) ... ... ... 116
LEVER (see Vectis) ... ... ... ... ... 116
viii
CONTENTS.
FAGB
AUJCj JL XlUOOUlrXJO ... ... , , ,
... 117
ill J!j X A U i. U ilL JSj O
... 118
... 130
... 137
... 138
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... 14.0
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... 141
... 143
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... 147
UTTT TrT'lVn?Ti*I?T> G
Jriiili V lluJb 1 XiiCo
... 150
Jr XjXlJ! UxlA 1 U Jib
... 163
1. The Wedge-Scissoes
... 164
... Ib7
o. IHE t/ONICAL C50KEW ... ...
... 168
4. The TuEPAIf-PEEFOEATOE ...
... 168
... 171
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174
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184
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birJCiC/ U LA ...
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CTTTiTJACTrpAT? TT?G /c'-ctt' T^pcic! a "DTT?a TW^TTTlTr' A T'X'T\^
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... aUO
TKUCAKo (SEE UTAEIOTOMT, INTEXJMENTS FOEj.
TEUSSES (see Abdominal Bandages).
UTEEINE SOUNDS ...
01 1
^11
TT A AATT^T A rTlATJ
213
VAGINOSCOPE
... 213
VECTIS OR LEVER ...
... 214
VESICO-VAGINAL FISTULA, INSTRUMENTS FOR
... 217
VULSELLA (see Fobceps, Miscellaneous).
"WOMB-SUCKER
... 220
LIST OF EXHIBITORS
... 221
Beitibh
... 221
FOBEIGN
... 224
LIST OF INSTRUMENTS PRESENTED TO THE SOCIETY'S
MUSEUM ... ... ■•• ••• - 227
A CATALOGUE AND EEPOET
OF
OBSTETRICAL AND OTHER INSTRUMENTS,
ETC.
This Catalogue has been compiled by the following gentle-
men : — The President, Dr. Baeites ; Drs. Gkeenhalgh, G-eatlt
Hewitt, Beaxton Hicks, Mr. G-askoin ; and the two Honorary
Secretaries, Drs. Meadows and Mtjeeat, the former of whom
acted as Editor.
CATALOGUE AND REPOKT
OP
OBSTETRICAL AND OTHER INSTRUMENTS
^Exhibited at the Conversazione of the Obstetrical Society of
London, held, by permission, at the Royal College
of Physicians, March 2%th, 1866.
ABDOMINAL BANDAGES, TRUSSES, &c.
Fig. 1.
A Belt fob use in Pregnancy, Obesity, and Oyaeian Dis-
ease, -was sent by Mr. Salt, of Birmingham, and is figured in this
illustration (fig. 1). It accommo-
dates itself to the size of the
abdomen, afi"ords support in the
upward and therefore right direc-
tion, and, from the inclination of
the threads of the india-rubber,
the support is applied in the
same parallel as that of the mus-
cular structures.
Two Abdominal Belts were shown by Mr. Salmon, Wig-
more Street, one of which is
represented in the subjoined
sketch (fig. 2). It possesses
the advantage of more completely
supporting the lower part of the
abdomen by means of a pelvic
strap, which fastens at the sides
over the elastic, and can be se-
cured there in such a way that
pressure can be increased at the option of the wearer, thereby
1
Fig. 2.
2 ABDOMINAL BANDAGES, TRUSSES, &c.
attaining more of an upward or lifting support, which is so de-
sirable.
Mr. Pratt, 420, Oxford Street, sent an Abdominal Suppoht, to
which (at the suggestion of Dr. Grueneau de Mussy) he has
attached a pair of drawers, in order to avoid the use of under-
straps in cases where the hips are high and angular ; also a belt
of calico lined with flannel, for use immediately after the opera-
tion of ovariotomy. It has a number of tapes to festen in
front over the wound ; can readily be loosened to examine
the dressing ; and exerts gentle but firm pressure on the walls
of the abdomen. It is frequently employed by Mr. Baker
Brown.
Mr. Russell, 58, George Street, Portman Square, exhibited a
SpiEAii Silk Banda&e for supporting the abdomen ; also a Spieal
Silk Sxockin&; and the Obsteteic Bandage invented by
Dr. Priestley.
A Peeineal Bandage, devised by Dr. Bloct, was s6nt by
Nyrop, Copenhagen ; an Abdominal Pad was exhibited by M.
Stille, of Stockholm ; and a Compeess foe aeeesting Uteeinb
HiEMOEEHAGE, invented in 1847 by Dr. Pretty, was shown by Mr.
Coxeter, London. This appliance calls for a further description.
It consists of a central pad, attached to two lateral ones, and a
band which encircles the abdomen. By means of a screw the
compression can be increased or diminished with great facility,
and dangerous haemorrhage may often be thus prevented.
Professor Giordano, Turin, sent a somewhat similar apparatus
for the arrest of loss of blood from the uterus. In this instru-
ment the pressure is made on the aorta alone, and can be easily
modified.
Mr. Salmon, Wigmore Street, exhibited a Bandage foe Um-
BiiiCAii Heenia, and also some India-eubbee Aie-pads for
supporting the perinaeum ; also an Obsteteic Bindee, which
•was originally 'M^eiited by Dr. Meadows, and modified by Dr.
Eastlake.
^r. Langhardt's Umbilical Belt was exhibited by Messrs.
Weiss and Son ; it is a very ingenious, though somewhat cumbrous,
instrument. By a clever mechanical arrangement, the pad is said
to remain stationary under all movements of the body, and
it has been worn by many patients on the Continent with good
result.
ABDOMINAL BANDAQES, TEUSSES, &c. 3
Mr. Salt, of Birmingham, sent a Tetjss toe Umbilical
Heenia, which is figured in the annexed sketch (fig. 3). The
novelty of the invention is the pad. It consists of a circular disc
or plate, into which is fastened a facing of soft leather, backed up
Fig. 3.
for solidity by thick paper, to give softness and flexibility to the
pad. An india-rubber cap is inserted, having a spiral spring coiled
within it, which is intended to retain' the bowel within the abdo-
men. The belt is attached to the pad by means of clasps, which
are made to clip the web without stitching, thus reducing the
cost and simplifying the apparatus. The ends of these clasps fit
into a series of holes in the pad in such a manner as to allow the
belt to move without displacing the pad itself. Mr. Salt has
modified this belt so as to make it convenient for unabilical
hernia in children.
Mr. Pratt also forwarded a Belt fob Infantile Umbilical
Hebnia. The pad is constructed of a series of small water-pads,
the pressure exerted by which is said to be continuous a.nd
elastic.
Mr. Pratt's Belt .fob Umbilical Heenia in the a^ult is
. constructed on the same principle.
Mr. Salt, of Birmingham, exhibited a truss which he calls the
Orthonemio Teuss foe Heenia ; it is represented in the an-
nexed sketch (fig. 4) ; was invented and patented by himself ;
, and is said to possess the following advantages :
1. It affords, in , addition to the usual inward pressure of
4 ABDOMINAL BANDAGES, TEUSSES, &c.
ordinary trusses, a second or upward (lifting) pressure, always
required for support of hernia.
Fig. 4.
2. By the peculiar mode in which the vertical or lifting
springs are attached to the pads, no displacement of them can
take place when once put in position, neither can there be any
friction on the skin over the hernial openings.
3. The facility with which the position of the pads may be
placed in relation to the median line of the abdomen ; and the
springs across the abdomen having curves coincident with it, the
spring of the truss lies more evenly against the body.
4. The back support consisting of two pads instead of one —
one placed above the horizontal line (spring) the other below —
gives greater stability to the front part on which the pads are
suspended ; hence this truss is more likely to remain in situ.
5. Every part of the patent truss is made by machinery
instead of by hand ; so that any portion damaged or soiled can be
rectified without the necessity of sending the truss to the instru-
ment-maker.
6. The pads are said to be an improvement upon the fringed
edges of ordinary trusses, in which the cushions made by stitching
are constantly chafing the skin ; but by turning these cushions
ABOETIOlSr INSTEUIMENTS.
5
into a metallic capsule or clip, the edges and surface of the pads
are very smooth and soft.
Dr. Woodward sent his Obsteteic Back Suppoetee. It consists
of a padded plate, "on the posterior surface of which two springs are
hinged, having their common centre formed by a rack-and- pinion
hinge, by moving which the springs assume an arched form. To
the extremities of the springs is attached a belt which encircles
the abdomen ; so that, in their effort to take a curved form, force
is engendered against the pad forming the centre of the arc, and
the requisite amount of pressure is exerted on the surface covered
by the pad. Dr. Woodward says that he has used this appliance
in a large number of labours, and his patients have expressed
themselves as being much relieved by its employment. The
specimen exhibited was made by Mr. H. Bigg, Leicester Square.
The Abdominal Belt foe use aftee Deliveet, invented by
Mr. Toulmin, was exhibited by Maw & Son, London. The abdo-
minal pad is attached to a circular spring, and constitutes an
easily applied and effectual support.
ABORTION INSTRUMENTS FOR REMOVAL OF
THE OVUM.
These were of two kinds — 1, Porceps ; 2, Scoops.
Forceps. — One, exhibited by Dr. Cory, consisted of two fenes-
trated blades 9 inches long, 2^ inches wide, the handles crossed
somewhat, so as to save space. They appeared to be very old, but
the authorship was not known.
Dr. Cory also exhibited an Ovum Foeceps, of which the accom-
panying drawing gives a representation (fig. 5) ; it is about one third
the size of the instrument. The blades are fenestrated, curved,
and shaped, as is seen, somewhat after the pattern of the ordinary
midwifery forceps. The handles being fixed together, the instru-
ment is intended to be passed up into the uterus entire, to seize
the ovum or any retained portion, and so effect its extraction.
6
ABOETION INSTRUMENTS.
Pi&. 5. *
Sir James Simpson's Otfm Poeceps are about 10 inches long
consisting of two portions, which, however, are fastened together
like a pair of ordinary scissors. The joint is in about the middle
of the instrument ; the ends of the blades proper are fenestrated
and gently curved, so as to be about f inch apart, and they are
roughened on the inner surface.
Dr. Eadford's Fobceps foe the eemoval or the Ovum con-
sists of two blades which are separable (fig. 6). Each blade is 13f
inches long. The handle of each is a circular bow (Uke those of
scissors) rather more than 1 inch in diameter. The shanks from
Fia. 6.
handle to pivot are 4^ inches long, and are at first narrow and
thick, but become gradually a little thinner but considerably wider,
being about ^ inch. This flattened surface extends on towards
the point for about 2 inches, becoming then narrower and round
until within an inch of the extremity. It now becomes oblong
(joining the blades proper), concave and rough inside (as repre-
sented in the sketch), and convex on the outside. The length
ABOETION" INSTEUMENTS.
7
from the pivot to the point is 7|^ inches. On the flat surface
of one blade (the upper) 5f inches from the handle end, there
is a fixed button-headed pivot, and in the other blade there is a
retort-shaped notch which admits the pivot, and from its shape
the two blades may be securely locked. Although the notched
blade lies on and moves upon the other (or pivot) blade, yet by
a small contortion made in the shank of the upper blade the
points most accurately approximate when closed.
M. Charriere exhibited a pair of Ovtjm Foeceps of Dr. Ward,
United States, consisting of a pair of fenestrated blades, one of
which was ingeniously made to rotate at the joint, so that it
could either fit closely within the other or be exactly opposed
to it.
Mr. F. Dunne exhibited a pair of Otitm Forceps. They
were made of wood, about 9 inches long, and resembled very
much in size, shape, and general appearance, a pair of glove-
stretchers ; they worked in the same way, by a central spring and
pivot. At their extremity were two or three teeth, made by
merely sticking in some bits of brass wire, obviously to facilitate
the seizing hold of the required object.
Prof Eizzoli's Ottjm Foeceps measured 13^ inches in length ;
they were straight, and fastened like a pair of scissors, the
handles locking and unlocking by a pivot lock. The blades
proper were 2^ inches long, fenestrated and straight ; the handles
were of the ordinary scissors kind.
Scoojis. — The scoops for the removal of the ovum were of two
kinds, and both were exhibited by the inventor. Emeritus Professor
Boujalsky, through Professor Hugenberger, of St. Petersburg.
The one was made of steel, 12 inches long; the other was a
counterpart of this in all except that it was made of boxwood.
They were scooped at both extremities.
ANTEVERSION, INSTRUMENTS FOR (see
Uterine Supports).
BANDAGES (see Abdominal Bandages, &c.).
8
BLtJNT HOOKS.
BLUNT HOOKS.
The blunt and sharp hooks so frequently used formerly for
alteration of the position, or for mutilation, and subsequent ex-
traction of the foetus, have, since tbe invention of the forceps,
fallen into comparative disuse. The blunt hook is now chiefly
had recourse to for facilitating or hastening the passage of the
breech, thigh, or arm, when arrested in their progress through
the pelvis, or where immediate delivery is demanded. The small
number of cases requiring the use of this instrument may, to
some extent, account for the few specimens exhibited, and the
slight modifications effected in its construction. There are one
or two, however, which merit more than a passing notice.
Prof. Lazarewitch's Blunt Hook consists of a straight steel
shaft 12 inches in length, the upper part of which, for about 2
inches in length, forms an angle with the shaft of 75°. At the
other extremity (handle) is a triangular opening, the base mea-
suring 1^ inches, the two sides each 2^ inches, between which is
Fio. 7.
an angle of 50°. The instrument is represented in the above
sketch (fig. 7).
BLUNT HOOKS.
9
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BLUNT HOOKS.
claims for his instrument the following ad-
vantages : —
1st. In extraction of the
child by the thigh there is no
fear of injury to the genitals,
owing to the hook being at a
right angle to the shaft instead
of being bent downwards in
a bow, as in the blunt hook
ordinarily in use.
2nd. In extraction the va-
gina cannot sustain any injury,
pwing to the rounded extre-
mity of the rectangular hook.
3rd. It may be used for trac-
tion upon the neck of the child
in its oblique position when
decapitation is necessary.
4th. For placing a plaited
silk noose over the child's foot,
as represented in the drawing.
5th. For returning the funis
when prolapsed during labour,
which can be effected by a
noose made by passing a'thin
narrow silk tape through the
eye in the extremity of the
hook. See the drawing (fig. 7).
Mr. Newham's Guide
Hook, which is shown in the
annexed sketch (fig. 8), consists
of a steel shaft somewhat en-
larged in the centre, 12 inches
in length, curved in the shape
of the letter S, having at its
extremities two simple blunt
hooks reversed, one measuring
1|- inches, the other 1 inch in
breadth, each with the addi-
tion of a prow or guide.
It has a shifting transverse
BLUNT HOOKS.
11
steel handle which can be attached to either extremity by means
of a screw to enable the operator to exert more force where
great resistance is encountered. The inventor states tha.t his
instrument possesses the following advantages, among others :
1st. That the prows or guides facilitate the introduction of the
hooks by their tapering extremities.
2nd. That, in certain cases, the smaller may very advantageously
precede the insertion of the larger hook.
Mr. Newham remarks, " It is not intended by this instrument,
however, to supersede the use of the ordinary blunt hook, for the
blunt hook may be used under circumstances in which it might
not be safe to use the guide hook. It is intended to supplement
many puirposes which the blunt hook is not constructed to carry
out."
Por further particulars see ' Obstetrical Transactions,' vol. vi, p. 7.
An instrument (inventor unknown) was exhibited by Dr.
Greenhalgh for the purpose of passing an extractor over the
thighs of the foetus in cases of presentation where such artificial
aid is required.
It consists of a rounded wooden handle 4 inches in length, into
which are inserted the two ends of a flexible piece of wire, forming
a loop seven inches in length. It is used in the following manner :
the looped end of the wires being curved to the extent required
are passed over one thigh, until it descends on the side of the
opposite one. Half a silk handkerchief or other flexible and soft
material is then to be inserted into the vrire loop, which should
then be retracted, leaving the handkerchief previously detached
from the loop for the purpose of extraction.
The advantages claimed for this contrivance are —
Ist. Its easy application.
2nd. The firm hold thereby procured on the presenting part.
3rd. The slight risk of damage to the child by the soft textures
employed for the purpose of extraction.
Dr. Radford's Blunt Hook. This instrument when complete
(with handle described with the Crotchet) is 12i ia. long. The
blade at its handle end is round, and has a rim in which there ia
a notch to receive the small lever-stop, and the same mechanism
for adjusting the handle as the crotchet. The blade becomes
thinner and wider (nearly in.) as it passes towards the bend ;
which makes a kind of hook forming a small segment of a
12
BLUNT HOOKS.
circle whose diameter is 2-^ in. Its surface is flat, and it is well
rounded off at the edges. This instrument is easily passed over
the thigh of the infant, causing less injurious pressure than the
ordinary blunt hook.
Dr. Oldham's Vebtebeal Hook. Specimens were exhibited by
Durroch and Coxeter. It consists of a long fine stem bent at an
acute angle at the end to form a hook, designed to take hold, in
the foramen magnum, in eases where the cranium is too much
broken up to afford a sufficient hold to the crotchet or craniotomy
forceps. It is figured in Churchill's ' Theory and Practice of
Midwifery,' 3rd edition, 1855.
The Sha-BP and Blttnt Hooks of Professor Martin, of Berlin,
were exhibited by Liitter. These are figured in * Martin's Hand
Atlas.'
CAUTEEISERS AND CAUSTIC HOLDEES. 13
CATITEIIISERS AND CAUSTIC HOLDERS.
Professor Nelaton's G-as Catjteet was exhibited by Mr.
Eerguson, and is represented in the subjoined sketch, fig. 9.
It consists of a small india-rubber bag" which is to be filled
with gas ; from this proceeds a small elastic tube about a yard
or so long, to the end of which is attached the cautery, a
stop-cock being placed so as to regulate the amount of gas going
to the latter. The cautery itself consists of a small tube of fine
wire gauze about an inch long and a quarter of an inch in
Fig. 9.
diameter. This is fixed at the end of a tubular handle 8 or
9 inches long. When in use, the gas issues at the gauze end,
where it is consumed ; the gauze ensures perfect combustion and
consequently great heat, which can be maintained for as long a
time as the gas in the bag takes to consume.
Galtanic Catjteet. — This instrument was invented by the ex-
hibitor, Mr. Robert Ellis, in 1852, an account of it being then
published with a number of cases of uterine diseases in which it
was successfully used. It was subsequently much improved, and
brought by the exhibitor to its present condition, and as such
was exhibited before the Obstetrical Society, and fully engraved
and described in the 'Transactions' for 1862. Its peculiarity
resides — 1st in the extraordinary activity and intensity of the
battery, which with only a single cell is capable of igniting a
considerable length of platinum wire ; and 2nd, in the peculiar
arrangement, by which the heat thus developed is accumulated and
apphed to the diseased surface.
.14 CAUTERISEES ANP CAUSTIC HOLDERS.
A .similar in8tr^ment was exhibited by Coxeter for use in
operations for vesico-vaginal fistula.
Mr. Ellis also showed his Pebfohated Caustic and Caustic
Fig. 10.
Fij.l.
Fig. 1 represents the caustic holder mounted on a quill, and fitted with
perforated caustic.
Fig. 2 shows the mould for the caustic, in section, with the «teel wire
which forms the core.
Fig. 3, a piece of perforated caustic.
Fig. 4, the cover with the aperture at its end.
CAtJTEElSESS AND CAUSTIC HGLDEES. 15
HoLDEE.— This invention was exhibited at the Western Medical
Society twelve years ago. The caustic then was in the shape of
bullets, perforated through the centre and held in place by a
platinum pin. In May 7th, 1862, the present form of cylindrical
perforated caustic was shown to the Obstetrical Society, with the
peculiar holder since known by the exhibitor's name. The in-
strument is represented in the foregoing sketch (fig. 10).
The simple idea of the instrument is the solid and unyielding
support given to the brittle caustic by passing a metallic ^pin
through the centre of the cylinder. To effect this the caiBstic
must be cast hollow, and this is accomplished by means of the
mould (fig. .2). The central perforation is made by passing a
polished steel pin through a hole in the upper and lower halves
of the mould, and the fused caustic is then poured into the
mould. On solidifying, the pin is easily withdrawn, and a hollow
stick is produced.
The caustic holder consists of a small socket of silver bisected
and carried on the halves of a slender metallic support, grooved
internally, and externally cut to a spiral thread, in which a nut
works to and fro. The cylinder of caustic drops into the so6ket,
and a platinum pin is passed through it and between the halves
of the stem. The whole thing is fixed in position by the little
nut which works upwards. The stalk of the instrument is of
porcupine quill, and the cover (fig. 4) is perforated atits>end
for the purpose of keepiug the caustic always dry and hard.
Dr. Marion Sims' Caustic Hoebee was exhibited by Messrs.
Mayer and Meltzer : it consists of a pair of long forceps with
sliding spring, the ends of the forceps being hollowed; so that
.when closed they form a tube which carries the caustic.
A Porte Catjstiqtje of M. Stille, of Stockholm, was exhibited
by the maker. The caustic was carried, as it were, in a catheter,
having one side open for a short space at its extremity, and by a
screw at the handle the open side containing the caustic could be
rotated so that the caustic presented itself at every part of its
revolution.
A somewhat similar instrument for liquid caustics was ex-
hibited by the same maker. It carried a small roll of sponge at
the end, which could be saturated with the solution of any given
caustic ; by pressing the stilet the fluid exuded through the per-
forations at the extremity.
16 CAUTEEISEES AND CAUSTIC HOLDEES.
Fia. 11.
Sir J. Simpson's Caitstic Holder for use without the specu-
lum was exhibited by Mr. Perguson. This instrument in principle
resembles the Forte Caustique above de-
scribed; it is represented in the annexed
sketch (fig. 11). When closed it resembles
the ordinary uterine sound, and as such may
be passed up to the cervix or other part
intended to be cauterised. By turning the
screw at the handle the caustic is pushed out
and rotated.
Dr. Savage showed a pair of Ctjbted
roECEPS, forming, when closed, a receptacle
for caustics, to be introduced within, the
uterus as well as for ordinary application.
The two small apertures correspond with
the trunnion pins of various lancets, knives,
&c., securing firmness as well as great por-
tability.
Dr. Eouth sent his Instrttment foe
TEODTTQIJSTG CatJSTIC IN UtEEO, OE FOE
DILATING THE INTERNAL OS, manufactured
by Coxeter.
This instrument, which is represented in
the following illustration (fig. 12), consists of
four parts, two blades, a piston, and a screw.
The blades are kept together as scissors
by a central pin (a). The upper portion
(b, c) is curved like a Simpson's sound.
The extreme end for about one inch being
grooved so as to receive a small thin stick
of caustic about one line thick. Between
these two blades is a piston which fits into
this groove (e), the handle of which (d) slips
up or down in two eyes or staples in one
of the handles. By pressing the end of the
piston (d), or drawing it downwards, it is
made to work in the groove. Thus if the end of the piston
is at b, on pushing it forwards, at the same time as the blades
are drawn out, the caustic remains in utero. By means of
the screw at the distal end (f, g), the blades are made to
Simpson's Porte
Caustique.
CAUTERISERS AND CAUSTIC HOLDERS. 17
open at the uterine end, and so the uterine internal os may bo
dilated.
Fig. 12.
18
CEPHALOTEIBES.
CEPHALOTRIBES.
The earliest instrument designed for crushing the bones of the
foetal skull appears to have been the " Compeessoe Fobceps "
(nuovo forcipe compressore) of Assalini. This instrument
formed one of the collection submitted to the Institut National
de France in 1810, and is described in Assaliui's ' Nuovi Stro-
menti, &c.,' Milano, 1811. It was designed by him to overcome
the cases of the second order of difficulty, those, namely, in which
the conjugate diameter was much under 3 inches or in which the
head was left behind after the detachment of the body. He used
it to crush the base of th.e skull and the face, and relates cases of
successful use.
Fio. 13.
Assaliui's Cephalotribe.
Like his forceps, modelled after Palfyn's idea of bringing two
levers into opposition, the blades do not cross. They are power-
ful bars, slightly curved to grasp the head, and are held together
at the ends of the handles, like his forceps. The crushing force
is effected by acting upon the middle of the blades ; the fulcrum
or centre upon which the arms move being the joint at the
proximal end of the handles.
The instrument most nearly resembling the original com-
pressor-forceps of Assalini is the Cephalotribe of Professor
Lazarewitch, of Charkoff, Honorary Fellow of our Society.
This instrument has a full pelvic curve in the blades. These are
scooped out on the inner sides, and are armed with three strong
pyramidal projections springing from the hollow of the blades,
and ending in points which look towards the handles. These are
calculated to help in breaking do^^'n the bones and also in
CEPHALOTRIBES.
19
securing a hold for traction. "Wlien closed the blades are J^ths
of an inch apart in the middle ; the extreme ends curve inwards
so as to touch. This distance then marks the limit to which
compression can he carried. The blades are 9*50 inches long.
The shanks then run parallel to the handles, which turn off at
right angles ; the shanks are 6*50 inches long ; they are united
near the handles by a stout flat bar projecting from one shank
which slips through a slit in the other. This arrangement is
known as Assalini's lock. This point of union forms the fulcrum
or centre upon which the two arms work. The compressive force
is applied by a screw which is carried through the shanks near
their junction with the blades. The blades are long enough to
carry the screw a sufficient distance from the vulva to obviate
inconvenience in working. The blades are introduced separately,
and, being little more than an inch wide, are easy of application.
The instrument was one of the lightest exhibited, and of the most
simple construction ; it weighs only 2 lb. The principal points
of the instrument as regards lock, &c., may be seen by referring
to this drawing.
Fig. 14.
The instrument exhibited by Professor Lazarewitch has been
presented to the Society by Dr. Barnes, President.
20
CEPllALOTRIBES.
The model of all the modern cephalotribes, excepting that of
Lazarewitch, is found iu the instrument of Baudelocque (fig.
15). The original instrument, designed, and described to the
Erench Academy in 1833, and used by the illustrious French ob-
stetrician, was presented to the Obstetrical Society of London by
Madame Petitjean, who inherited it from the inventor. This
interesting gift was made through the intervention of Sir Charles
Locbck, our Honorary President.
The extreme length is 21 inches, the length of the blades,
measured from the lock, is 9' 75 inches. The lock resembles the
French forceps-lock. The compressive force is obtained by a
Fio. 15.
travelling-screw which runs in a female-screw in the left handle
and through an oblong slit in the right handle. The screw is
worked by a winch-handle (manivelle). The blades are sUghtly
curved, being 125 inches apart at the greatest distance, and
touching when closed at the points. The points are smootlUy
rounded. The inner surface of the blades is scooped out into a
shallow smooth concavity. The blades widen gradually from the
lock towards the ends, being 150 inches wide near the ends.
The blades have a considerable curve. The weight is 4^ lbs.
A modification of Baudelocque's instrument, by Lueh, was
exhibited by Luer, of Paris.
The Cephalotiiibe of Professor Depaul, Honorary Fellow of
CEPHALOTEIBES.
21
our Society, was exhibited by Sir James Simpson, made by Mathiou,
of Paris. Tliis is a massive instrument, measuring 24 inches in
length. It is fitted with the French forceps-lock. The blades
haA'e a considerable pelvic curve, are a little more than an inch
wide, without fenestra. The inner surface of the blades is studded
near the end with small projecting teeth, to improve the grasp
upon tlie head, and the ends are curved inwards to form crotchets,
which, meeting when the blades are fully closed, leave a space of
half an inch between the blades.
The instrument is worked by a chain fixed to the left handle,
which is wound up on a drum on the right handle, and is turned
by a double lever. The power is indeed that of the winch.
Another specimen of Depaul's instrument, of later date than
the preceding and modified, was exhibited by Charriere, of Paris.
It is figured in the annexed illustration (fig. 16). This specimen
Fig. 1G.
is described as the Ccphalotribe a. cremaillore. It has the
crotchets at the end of the blades, and, in addition, is furnished
with the detaching-joints of Charriere. The handles are brought
together by a jointed chain fixed to the right handle, which is
worked by a cog-wheel.
ETLT2faER AND Hugenberger's Cephalotribe, a modification
of Baudelocque's, was exhibited by Pi-ofessor Hugenberger, of
St. Petersburg, Honorary Fellow of our Society, and is shown in
this drawing.
Fig. 17.
22
CEPHALOTRIBES.
The modilicatiou consists in the instrument being made lighter
and shorter than Baudelocque's, yet retaining its strength. The
weight is 3 lb. 4 oz., the length is 20-50 inches ; Baudelocque's
is 21 inches. The blades also have a greater pelvic curve, they
are narrower, so that they can be introduced more easily, and
meet more closely ; they have Busch's lock. The right handle
has Braun'a hook ; the inner part of the left handle is supplied
with a screw to bring the handles together.
The Kephalotiiyptob of Professor Ed. Martin, of Berlin, was
exhibited by the inventor, and is figured in Martin's hand atlas.
The length is nearly 24 inches. It has a considerable pelvic curve.
The blades are curved inwards at the ends so as to meet. The
distance between the blades when thus closed is 1"75 inches.
The lock is like the English forceps-lock, and just below the lock,
on each handle, is a shoulder or rest for the fingers to aid in
extraction.
The instrument is worked by a powerful screw running through
both handles, and turned by a double lever. It was exhibited by
LiiTTEB, of Berlin.
The Cepkaloteibe of Bbaun, of Vienna, exhibited by Weiss,
is represented in this sketch (fig. 18). It will be seen that one
Fig. 18.
of the handles is divided into two by a jointed portion, provided
with a hook, which fixes on a sort of movable cross-bar attached
to a screw which works on the inner side of the other handle.
By turning the screw with the cross handle at the end of the
instrument the cross-bar is pulled up or down, and this, acting
upon the jointed portion of the opposite handle, opens or closes
the blades.
Another specimen of Braun's Cephalotbtbe was exhibited
by Stille, of Stockholm.
The Cepiialotribe modified by Camillus Nyuop, of Copen-
hagen, date 18G6, was exhibited by C. Ntbop.
The handles are brought together by means of a screw, which
CBPHALOTRIBES.
23
travels up and down on a shaft in a groove between the handles,
so as to approximate the blades and crush the foetal head. The
blades are curved, grooved on their foetal aspect, and a row of
teeth are placed along the centre of the groove. The lock is of
the ordinary pivot or button, form ; the blades cross. This in-
strument is represented in fig. 19.
Fig. 19.
Professor Cohen's Cephalothibe presents this peculiarity,
that in addition to its power as a crushing instrument each blade
is armed with a cutting blade, by means of which the head is, as
it were, bisected. This, no doubt, greatly facilitates the after
crushing, and enables the instrument to be of a lighter description.
Fig. 20 represents this instrument.
Fig. 20.
24
CEPHALOTRIBES.
The Cephalotbibe of Professor Rizzoli, described in Eizzoli's
work * Instrumenti d'Ostetricia,' Bologna, 1856, was exhibited
and presented to the Society bj Professor Rizzoli, Honorary
Pellow of our Society.
The general construction is after the model of Baudelocque's
instrument, but it is much improved in lightness and neatness.
The length is 19'50 inches ; the length of the blades from the
lock is 9-50 inches. The lock is the French forceps-lock, but
differs from Baudelocque's in this, that the fulcrum is formed by
a screw which serves to fix the blades when adjusted. The
handles, being 10 inches long, are flat bars brought one over the
other when the blades are closed, thus forming very powerful
levers. They are brought together by a screw worked by a
winch, so far like Baudelocque's, but differing in this, that instead
of a simple oblong slit in the right handle, Rizzoli's right handle
is an open fork, so as to admit of the screw revolving on a joint
which fixes it to the left handle. This arrangement offers a great
convenience in packing the instrument, and also in adjusting the
screw for work. The blades have a more moderate pelvic curve
than Baudelocque's or than most other French cephalotribes, but
in other respects resemble Baudelocque's. They are lighter and
narrower. When closed the points touch, and the extreme width
between the edges of the blades is barely -50 inch. The blades
are, however, deeply concave ; the concavities are smooth. The
effect of the nairowing of the blades, and the deep concavity,
is to make the edges prominent and sharp, so that these would
easily break into the skull as the blades are closed. The weight
is 31b. 9 oz., which is very considerably below that of its proto-
type, the original instrument of Baudelocque ; at the same time
it is a powerful weapon, quite if not more than sufficiently
strong to crush the head of any foetus, and the close approxi-
mation of the blades secures a complete reduction of the cranial
dimensions.
The Kephalotetptob of Professor Hennio, of Leipzig, date
18G5, was exhibited by the inventor.
This instrument is designated the Kephalotryptor a crochets.
It is armed with hooks or crotchets in order to grasp the hend
more firmly and to facilitate extraction after crushing. The
CEPHALOTRIBES.
25
crotchets (vide fig. 21) if not needed may lie guarded or concealed.
The hooks also serve as handles in extraction. When wanted
Fig. 21.
to seize the head the crotchets are started out by pressing upon
the handle and then puUing the hook down. By a reverse
manoeuvre the head can be set free from the hooks.
Professor Hennig's instrument works with a screw^ running
through the ends of both handles, and turned by a winch, like
Baudelocque's original instrument. The total length is 24 inches.
It is very massive.
The specimen exhibited is in the Museum of the Society, pre-
sented by Dr. Hennig.
The Cephalotribe of Scanzoni, Honorary Fellow of our
Society, was exhibited by Sir James Simpson. Length about 21
inches. The blades articulate by a Briinninghausen's lock. The
blades are without fenestra, have a moderate pelvic curve, meet
at the end, and leave a maximum distance of an inch and a half.
The inner surface of the blades is slightly concave, and has a ridge
running down the middle. Just below the lock the handles are
furnished with shoulders to facilitate manipulation. The com-
pressive force is obtained by a peculiar mechanism : a bar travels
over both handles. AVhen the handles and therefore the blades
are open or divergent, the travelling bar runs up towards tlie
lock. As the bar is made to travel downwards towards the
diverging ends of the handles these are brought together. This
movement is effected by a screw fixed to the inner aspect of the
left handle, and running parallel with this handle through the
26
CEPHALOTRIBES.
middle part of the bar. The screw turned by a double lever
brings down the travelling bar and thus draws the handles to-
gether.
The Cephalotribe of Kiltan, of Bonn, was exhibited by Sir
James Simpson.
This is a (•massive instrument, resembling generally that of
Baudelocque's. Its length is 25 inches. The blades articulate
by the French forceps-lock. The compressive force is obtained
by a toothed and graduated bar, forming the segment of a circle,
fixed to the extreme end of the left handle and travelling through
a slit in the right handle by means of a cog-wheel worked by a
winch.
The Cephaloteibe of Sir James Simpson, Honorary Fellow
of our Society, was exhibited by Young, of Edinburgh, for Sir
James^Simpson.
This instrument is the lightest and smallest of all the cepha-
lotribes, without being deficient in power. The length is about
14^ inches ; the blades have a slight pelvic curve ; the union is
by the English forceps-lock ; the blades are nearly parallel, but
curved at the ends, so that they touch ; the extreme distance
between the blades is about 1^ inch, they are rough^ on the
inner surface. The compressive force is effected by a screw
running through both handles, near the ends, worked by a fly-
nut.
Dr. Sohollee's Cephaloteibe.
This is a massive powerful instrument, generally resembliug
Baudelocque's. It is worked by a screw running through the
handle-ends, and turned by a bar-lever. It was exhibited by
Prof. Nyrop, of Copenhagen, and is represented in this sketch.
Pig. 22.
CHLOEOFOEM INHALEES.
27
CHLOROFORM INHALERS, &c.
Dr. Eichardson exhibited his
Anjesthetic Speat Peodtjcee.
This apparatus consists of a bottle for holding the volatile
fluid, of a special tube through which the fluid must be passed
to be distributed or pulverized, and of a small pair of hand or foot
bellows for the dispersion of the fluid from the tube, as is shown
in this sketch (fig. 23).
Fig. 23.
In preparing to use the apparatus, first charge the bottle with
the volatile fluid. Next connect the spray-producing tube with
the bellows. Lastly, insert the spray tube firmly into the bottle.
The bellows are to be firmly worked at the rate of one stroke
per second. The second bulb of the bellows, surrounded by silk
network, wiU soon become distended so as to sustain the pressure,
and a fine spray of ether will escape from the end of the spray
tube.
In putting together the apparatus, it is necessary to see that
the connections between the tube and the bottle, and between
the bellows and the tube, are perfect.
The spray thus produced when it is directed upon the body
causes the insensibility.
The free end of the tube through which the spray is delivered
may be quite plain, or may be furnished with a cap, which is
removable at pleasure. When the cap is removed, the capillary
tube conveying the fluid will be found in tlie centre of the outer
casing or tube, and in it a needle. This needle regulates the
supply of ether, and needles of two sizes are sent with each appa-
ratus. If the operation to be performed is very small, the large
needle is to be inserted, by which tlie spray is rendered extremely
28
CHLOROFOEM INHALEK.S.
Fia. 24.
fine. If the operation is larger, the smaller needle is inserted,
and a freer spray is secured. In some cases the needles may be
removed altogether, when, if the instrument acts well, a very large
rush of spray may be obtained.
Sjjecial Apparatus. — For small operations and for ordinary use,
the single jet above described is employed ; but Dr. llichardson
lias added other tubes for special purposes, which he thus describes :
In the Double Converging Jet (fig. 24) the jets
terminate in two points, curs^ed towards each
other, the currents of spray crossing about an
inch from the points of the jets. This tube
is used especially for the extraction of teeth.
Wben the spray from it is to be directed
on one point, it should fall on the part about
the eighth of an inch beyond the line where the
currents cross. If it be necessary to narcotize
two points, the spray should be directed about
a quarter of an inch within the line where the
currents cross, or about^a quarter of an inch, or
from that to half an inch, beyond.
Multiple Sprag Tube the spray is delivered from
three or more parallel jets. This tube is used
in cases wbere a surface of from two to three
inches requires to be narcotized ; and, also,
where a moderate degree of insensibility has to
be induced over a very large surface, as in lum-
bago.
The Probe Sprag Tube is made like a common
probe ; it delivers a fine spray, and is useful when-
ever the spray requires to be directed into a sinus
or cavity.
The Lateral Sprag Tkibe is closed at the extreme
end, but has from one to three openings in the side,
near to the end. It is used in cases where a side
spray is necessary.
The Straight or Uterine Sprag Tube (fig. 25) is per-
forated in one, two, or three places at the point. It is
intended for directing the spi'ay deeply into cavities
of the body.
"Where a surface of skin several inches long
lias to be divided, a large double or triple Jet must be
Fi&. 25.
. f
f
CHLOROrOllM INHALERS.
29
Fig. 26.
employed. The jets may be inserted
into a three-necked metal bottle
charged with eight or ten ounces of ^
ether, as shown in the diagram (fig. 26).
With an apparatus constructed in this
manner, sufficient insensibility may be
produced in forty-five seconds to en-
able the operator to perform capital
operations painlessly.
Another instrument on a similar
plan has been constructed for large
operations, using two bottles instead
of one, and bringing them together
in a small leathern case. Covered
with felt, it retains the ether or other
volatile fluid when not required for
immediate use.
The Spray Catheter (fig. 27) is a tube
made like a female catheter, and is used for injecting narcotic
spray into the bladder or any sac. The spray is delivered with-
out subjecting the part into which it is dis-
persed to any pressure from distension.
These instruments were all made for Dr.
Eichardson by Messrs. Krohne and Sese-
mann, of 241, Whiteohapel Road.
Dr. Richardson insists on the necessity
of having pure ether, which should have a
sp. gr. of •723. It should boil in the palm
of the hand. Taken on the tongue, it should
evaporate at once, leanng no sensation what-
ever except that of slight coldness. Directed
as a spray on the bulb of a thermometer, it
should bring the mercury down six degrees
below zero Pahr.
Messrs. Garden and Robbius, of Oxford
Street, are mentioned as selling ether of
the requisite purity, some of which they
exhibited. They also exhibited samples of
three other preparations of ether introduced
by Dr. Richards^ou, viz. —
Fia. 27.
30
CHLOROFOEM INHALERS.
I. loDizEB Ethereal Oil.
This preparation is composed of iodine, absolute ether, and pure
oil. It is said to form a good dressing for recent wounds or
incisions, but is especially applicable for suppurating or open
surfaces in which there is a foatid discharge. It may be applied
directly by a camel-hair pencil. Lint saturated with this solu-
tion and applied to the affected surface, if excluded from the
air, does not adhere, and may be readily removed without giving
pain.
II. OzoNic Etheb.
This ether contains ozone, and diffused from a spray tube in the
sick-room, or allowed to evaporate from a linen cloth, rapidly
fixes ammoniacal compounds and deodorizes the air. It may also
be inhaled from a pocket-handkerchief in quantities of one or two
teaspoonfuls, in cases where the medical practitioner sees^ its
applicability.
III. Xtlo-Sttptio Ether.
This ether is to be used with a spray tube, so as to combine
the effects of the styptic with the constringent influence of
extreme cold. The spray produces most rapid congelation, even
of defibrinated blood. It also arrests decomposition of blood.
Dr. Sansom exhibited his Chlorofobm-Inhalee which is
represented in the subjoined illustrations (figs. 28, 29).
Fig. 28. Fig. 29.
Sitting Position. Kccumbent.
CHLOEOrORM INHALEES.
31
This instrument is so constructed as to cause not only a due
dilution of the chloroform-vapour with air, but also a gradual
increase in the proportion of the former from the commencement
of the inhalation until the attainment of anaesthesia : it thus
induces a tolerance of chloroform.
Mode of Use. — A drachm of chloroform is poured upon blotting-
paper loosely placed in the receptacle ; an interstratum of gutta
percTia prevents undue cold during vaporisation ; by means of a
joint in the horizontal tube the receptacle can be kept in the
upright position, however the patient may be placed ; moreover,
the whole instrument revolving on the mouthpiece, it not only
adapts itself to any position of the face, but it can be turned
from one side to the other to suit the convenience of the surgeon.
At the commencement of the inhalation, the valve of the face-
piece is turned off, and the apertures in the tube next to the
facepiece are left perfectly free to the air ; after two or three
inspirations in this condition, wherein the chloroform is neces-
sarily very highly diluted, the outer tube is gradually turned so
as to occlude the apertures of the inner one ; then the valve of
the facepiece is also gradually turned so as to cover its aperture.
By these means a gradually increasing proportion of chloro-
form is inhaled, the patient is rendered tolerant of the vapour,
and narcotism is attained without discomfort or danger.
The instrument is very portable, and is half the price of the
inhalers now in use. It is made by Matthews, of Portugal
Street.
Dr. Sansom also showed his Chlorofoum Inhaler for Ob-
stetric Purposes. — The instrument just described succeeds very
weU in the production of anaesthesia during natural labour, and
for the performance of obstetric operations. By keeping the aper-
tures of the exit-tube more or less closed, any dose or proportion of
cliloroform vapour may be administered according as the pains or
other circumstances require. The following modification of the in-
haler is, however, from its portability as well as efficiency, more
useful for obstetric purposes (fig. 30).
As will be seen by the diagram, the whole instrument is con-
structed to close like a telescope, so as to occupy the least possible
space. A is a reservoir constructed of silk and flannel, and con-
taining a surface of cambric on which the chloroform is poured.
B is a tube of perforated metal, which, by being pushed more or
82
CHLOROFOEM INHALERS.
Fig. 30.
less into the tube c, regulates the admission of air, and con-
sequently the dilution of the chloroform vapour, d is the face-
piece. In the course of a confinement, the medical attendant
having previously arranged the tube b so as to administer the
proportion of chloroform which he requires, the patient can her-
self with the greatest ease apply the inhaler, or this duty may
be delegated to the nurse.
The subjoined sketch (fig. 31) represents, in miniature, Dr.
Skuwee's Appabattjs for what he describes as the more safe,
effectual, and economical administration of chloroform, which
he thus mentions : —
Fig. 31.
" For all that I know, the means may be nothing new, but they
suggested themselves to me late in December, 1861, on hearing
of the method introduced by Sir James Simpson, of administering
chloroform by drops on a muslin or cambric handkerchief ; which
method, however advantageous, is subject to two objections,
CHLOEOFOEM INHALEES.
33
namely, (1) Tlie difficulty of dropping the chloroform and of
seeing where you are dropping it ; and (2) The difficulty of pro-
tecting the patient's face from being irritated by the anaesthetic,
even by inunction with ohve oil. This inhaling apparatus the
author believes will not only obviate those inconveniences, but
render the inhalation of chloroform less dangerous and more
effectual in smaller quantities, and be consequently more econo-
mical.
By the old method, when the labour-pains were severe, as
as much as one and a half fluid ounces an hour were often used ;
whereas with this inhaler and drop-tube the operator can easily
anaesthetize a case of labour at the rate of half an ounce an hour,
which is equal to a saving of about sixty-five per cent, of cMoro-
form; no small consideration. For the last five years Dr. Skinner
has never used any other than metlii/lated chloroform, which he
finds to be quite equal to that prepared from the best rectified
spirit, thereby the practice of anaesthetic midwifery is still further
economised ; and the quantity of chloroform consumed may be
still further lessened by withdrawing the inhaler at every expira-
tion of the patient.
The apparatus is composed of a mask or inhaler for receiving
and evaporating the chloroform, and a bottle with a peculiar
form of drop-tube attached, which is called the magazine regu-
lator. '
Description. — The framework of the mask is of tinned iron
or German silver, or silver-plated wire. It somewhat resem-
bles a fencing mask, excepting that it is covered with fine
domette or Welsh flannel instead of wire gauze, and that it
covers only the lower half of the face. For convenience,
it has a movable handle, and is otherwise made to fold
up so that it may be carried in the pocket, hat, or case, A
form of the inhaler has lately been constructed by the original
makers at the author's suggestion, /or especial use in hospital prac-
tice, which does not fold up. As a natural consequence, though
not so portable, it is both stronger, more durable, and cheaper than
the one just described.
The drop-tube is a tube of glass or metal, about one and a
half inches long, and so far sealed at one extremity that a silver
wire ligature only can pass ; it is then thrust through a perfo-
rated cork which is inserted into a four-ounce phial of green or
3
34
CHLOROFORM INHALERS.
blue glass, and the magazine-regulator is ready for use. Tlie
cork is more durable if covered with white kid leather. Messrs.
Maw and Son have greatly improved this drop-tube by making it
and the stopper one, and entirely of glass, as represented in the
woodcut.
On inverting the magazine-regulator with chloroform in it, at
no single inversion can more than thirty minims escape until it is
reinverted. The principle of this invention is, that no more
liquid can flow at one inversion than is sufficient to allow the
atmospheric pressure to balance the elastic force of the vapour
of chloroform and air within the bottle. It might be called a
pneumato-hydraulic regulator of chloroform. As the apparatus
is free from mechanical valves, sliding tubes, and other imneces-
sary and dangerous comphcations, it is safer to use and less liable
to get out of order than other forms of chloroform-inhalers.
Directions for Adjusting. — 1. Examine well the bearings of
the mask or inhaler before attempting to adjust it.
2. Be careful not to apply much force in the adjustment, as
scarcely any is required.
3. Adjust the domette or flannel cover by passing the handle
of the inhaler through the slit up to the hinge ; then draw the
india-rubber opening over the wire frame, keeping the side on
which the facial or horizontal wire is, looking upwards.
4. Adjust the horizontal or facial wire (under the domette),
and keep it in position until you have unfolded the handle. See
that the small notch in the hinge extremity of the handle receives
the facial wire, and fixes it ; then turn the instrument over, and
fix the nut or bolt beneath the handle.
N.B. There are two covers with each instrument. When
soiled, or, indeed, after administering chloroform to any patient,
afresh cover should always he put on, and the one used should be
washed with soap and cold water, and dried uustretched in a dry
atmosphere or in a drauglit of cool air. The washing need only
occupy a few seconds.
Directions for Using. — 1. Never charge the bottle with over
three fluid ounces of chloroform, namely, to the top of the tell-
tale or slit in the leather cover; otherwise the contents will
not flow freely enough when wanted.
2. In adjusting the tubular stopper, see that it is firmly " sent
home" with a turn, so that there will be no likelihood of its
CHLOEOFOEM INHALEES.
35
fallins out during use — an accident which hitherto has not
happened.
3. The inhaler or mask is to be held with the left hand, close
to, or more or less distant from, the nose and mouth of the
patient, whilst the chloroform-bottle, with the small glass cap
removed, is to be held in the right hand, and its contents are to
he poured in a stream over the surface of the domette (while in
situ over the face of the patient) in such quantities as the ad-
ministrator may think advisable. In fact, the bottle is to be used
the same as a watering-pot for flowers. But it is necessary to
bear in mind that, in consequence of the peculiar construction of
the stopper, only from fifteen to thirty minims can flow at one
inversion of the bottle ; air must be readmitted, either by a fresh
inversion, or hy sTiaJcing the bottle while in the inverted position, in
order to re-establish and keep up the flow when necessary.
N.B. For the future, Dr. Skinner adds that he will acknow-
ledge no apparatus as his unless manufactured by Messrs. Maw
and Son, of 11, Aldersgate Street, London.
Mr. Egbert Ellis showed his instruments for producing
Anaesthesia bt Mixed Vapoubs.
The first of these was the original model made by the exhibitor
for the application of this new ^
. . , Y ^1 • •
principle oi separately vaporising
the alcohol, ether, and chloroform,
and described in the ' Lancet '
for February 10th, 18G6. This
model apparatus, which is figured
in this sketch (fig. 32), was pub-
licly used at St. G-eorge's Hos-
pital in January, 1866. It con-
sisted of two separate chambers,
in one of which alcohol and ether
were vaporised, and in the other
chloroform. The mixed vapours
were conducted through the
lower part of the instrument and
administered to the patient by
an ordinary mouthpiece. But
the instrument exhibited thia
peculiarity in addition to the
36
CHLOEOFOEM INHALEES.
separate vaporisation of the anaesthetic fluids— that it contained
a simple and perfect regulation of the quantity and a precise
index of the quality of the vapours received by the patient.
The next was an improved model made to the exhibitor's design,
but on precisely similar principles. In this and the following
apparatus (fig. 33) the internal arrangements are precisely similar,
Fig. 33.
differing only in adaptation to the different shape of the instru-
ments. The arrangements invented by the exhibitor for perfect
control over the evaporation of ether and chloroform are as fol-
lows : — "Within the chambers appropriated to each of these fluids is
a small glass tube holding about sixty minims. Into this a few
strands of cotton wick are introduced, and when charged with the
chloroform or ether the capillary attraction of the wick liberates
an exact quantity per minute of either fluid. The actual amount
liberated on the exhibitor's system is never allowed to exceed
three per cent. By this simple contrivance the greatest security
is given to the operator against an overdose of chloroform.
CHLOEOFOEM INHALEES.
37
The provision of a system for alcohol vaporisation is also a
peculiar feature of these instruments. With a few pieces of
brass wire a little cage is made, in miniature representing the
arrangement adopted in floor-cloth factories, but really designed
from a consideration of the respiratory apparatus of the fish.
After much trial the very best material for evaporating the
alcohol was found to be the beautiful cambric frilling made at
Coventry, and perfectly free from all "dress." This fabric, an
inch in width, was passed alternately over cross-wires at the top
and bottom of this little frame, untU fifty inches of it were con
tained in a space not more than three inches in depth by one
inch and a quarter in diameter. Thus, hanging in vertical folds,
the air inhaled passes over it without impediment, and in its
course robs it of the alcohol which is poured on from above. If
it be desired, so powerful an impregnation of alcohol vapour can
he thus got as to be almost too irritating for use.
In addition to the precaution already described as to an over-
dose of chloroform and ether, the apparatus has a precise regu-
lator which only permits of a certain quantity of vapour passing
Fig. 34..
38
CHLOEOFOEM INIIALEES.
through at one time, and indicates this by a scale corresponding
to the amount inhaled.
The last improvement of these instruments for compound
anaesthesia is the third model (fig. 35). This consists of a metal
cylinder about three inches in height by two and three-quarter
inches in diameter. On one side near the upper part, the tube f
emerges, which conveys the vaporised air from the chambers
contained in the cylinder. This elbow tube has attached to it
the valve g for admitting air at the commencement of the pro-
cess, and it is movable, so as to adapt itself to the different
positions of the patient. Penetrating the cylinder, it commu-
nicates with a small circular chamber, at the bottom of which
are two apertures, one connected with the chloroform side, and
the other with the alcohol and ether.
The different currents of air charged
with vapours are thus caused to
come together at the bottom of this
chamber, and the openings in it are
covered by a circular valve perfo-
rated in one half so as to correspond
with these openings, the other half
being left blank. This is seen by
referring to the section exhibited in
fig. 35. A little consideration will
show the reader that if this flat plate
be turned by a pin passing through
its centre, it will, according to the
direction of the rotation given to
it by the pin, uncover either one or
other of the openings, and at one
part both are wide open. After a
few inspirations the air valve is gradually closed, and the index
finger is advanced by single degrees up to ten. This is the point
where chloroform influence faintly commences. The index is now
moved still more gradually until it marks seventeen or eighteen
degrees on the scale. Of these degrees, ten represent the mixed
vapour of alcohol and ether, and the remainder that of chloroform.
It is very seldom necessary to advance the index farther than
this point in a confinement ; but for a surgical operation it will
perhaps be necessary to go beyond it, and to give the vapour
CHLOEOFOEM INHALEES.
39
uninterruptedly from both sides of the apparatus ; or if very dee])
anaesthesia be demanded, then the index must be taken a full half
turn onward, so as to give the predominance to the chloroform,
and render the alcohol and ether mere auxiliaries. At no point
is it capable of giving a dangerous dose to the patient. At a
point opposite to the elbow is a small space marked " Off," indi-
cating that when the finger is at that point, no vapour whatever
can leave the apparatus. Thus it can be turned olf in the inter-
mission of inspiration, and the waste of the fluids prevented.
The cliambers for all three fluids are, as in the former ar-
rangement, quite distinct ; but those of alcohol and ether com-
municate with each other at one point. The fluids are supplied
by pouring in a measured quantity through each of the funnel-
shaped openings in the lid of the instrument. The aperture for
supplying the ether is, in consequence of its excessive volatility,
kept covered with a shifting metal plate, which is turned aside
when the ether is poured in. The chloroform and ether chambers
contain the small reservoirs (the test-tubes) as in the other in-
strument.
In connection with the subject of Inhaleus, Messrs. Eobbins,
operative chemists, Oxford Street, exhibited Dr. Beigel's Uni-
FiG. 36,
40 CHLOllOFORM INIIALEES— CRANIOCLAST.
VEBSAL Inhalee, foi oxygen and other gases, volatile fluids, and
medicated vapours in general, a representation of which is here
given (fig. 3G).
The following are the directions for use : — Having removed the
cap of the inhaler, put into the vaso as much of the powder,
" patent oxygenerator," as would fill an ordinary wineglass, on
which pour half a pint of boiling water, pure oxygen is steadily
evolved ; replace the cap, inhalation may commence immediately,
be continued from ten minutes to a quarter of an hour, and
repeated once or twice a day. Volatile fluids and medicated
vapours are employed in a similar manner, first putting the
requisite quantity of the remedy into the inhaler, and then pouring
on it half a pint of boiling water, the necessary supply of atmo-
spheric air passing into the inhaler through the glass tube.
Should it be desirable to use a smaller quantity of fluid, the
glass tube passing through the cap and cork,
Fig. 37. with a gentle pressure, may be carried lower
down. The vase may be first made warm
with hot water before use, if necessary.
The annexed section of the mouth-piece of
this inhaler (fig. 37) sufBciently explains its
construction : — The two valves (a and b)
are made of vulcanite, and, acting extremely
easily, close and open with great precision.
It is obvious that the inhalation of the oxygen
with each inspiration — during which the
valve B gets closed — takes place in the direc-
tion of the arrow at A ; while during expira-
tion A closes, and the expired air escapes
in the direction of the arrows at b.
CRANIOCLAST.
SiE James Simpson's Cuanioclast, or, as it might be called,
craniotomy forceps, has the male and female blades somewhat like
those of Murphy's craniotomy forceps, but the shank of the male
blade rises in an elbow just before the joint, leaving a space
between the shanks which would receive a fold of scalp and
obviate pinching in the lock when the blades are closed. The in-
strument was exhibited by Yotjng and by Feeqttsoit.
CRANIOTOMY FORCEPS.
41
CRANIOTOMY FORCEPS.
Ceaniotomt Fokceps, to seize and hold the head for exl raction-
after perforation, seem to have been first employed bj Mesuakd.
A great variety were exhibited.
An old pair, with an S-shaped curve in the shank, toothed on
the inner surface of the blades, and having the English forceps-
lock, was, exhibited by Dr. Cobt.
Dr. Datid Davis's Craniotomy Eoeceps (internal), toothed.
The blades fi.t within the skull. Figured in Davis's ' Operative
Midwifery,' 1825. Exhibited by Dr. Hall Davis.
Dr. D. Davis's Ceaniotomt Foeceps (external), toothed. The
blades are applied outside the head. 1824. Exhibited by Dr.
Hall Davis.
Hamiltok's Ceantotomt Foeceps. The blades are united
by a fixed joint. Exhibited by Dr. Radfoed.
Holmes's Cbaihotomy Foeceps. iJxhibited by Dr. Radfoed.
Dr. David Davis's Guaeded Body Crotchet Foeceps.
Figured in Davis's ' Operative Midwifery,' 1825. This instru-
ment resembles Mesuard's double crotchet, figured and recom-
mended by Smellie.
Conquest's Ceaniotomy Foeceps. The blades have long
spikes on their inner surface to seize the skull, one is applied
inside, one outside. They work on a fixed scissors-joint. Ex-
hibited by Feeguson and Dueeoch.
Levee's Ceaniotomy Foeceps work on a fixed scissors-joint.
The blades are much curved ; have no fenestras. Exhibited by
Dueeoch.
Peiestley's Ceaniotomy Forceps.
This instrument resembles Dr. Lever's, except in the teeth,
which are disposed in three rows on one blade and in two rows
on the other. ^ The central row of teeth of the triple-rowed blade
is received into the groove between the two rows of the opposite
blade, whilst the other rows, opposing each other, perfect the
grasp. The blades cross, and are united by a fixed scissors-joint.
Exhibited by Matthews, London.
Radford's Ceaniotomy Foeceps.
This instrument consists of two blades, which are introduced
42
CEANIOTOMY FOECEPS.
separately, and articulate by the English forceps-lock. The total
length is 15^ inches. The length of the handles to the joint is
8 inches. The blades are slightly curved. The external or female
blade is ribbed on the concave surface, and has three perforations
in it to receive three teeth projecting on the convex surface of
the internal or male blade, which has ribs similar to the external
blade. (See fig. 38.)
Fia. 38.
Dr. Mtjephy's Ceaniotomt Eoeceps, 1845.
The blades are male and female. The female blade is fenes-
trated, and has transverse ribs to receive the male blade, which is
solid, and has transverse or duck-bill ribs. The blades are united
by scissors-joint, and are almost in a line with the shanks. Ex-
hibited by CoXETEE.
Baenes's Ceajtiotomx Foeceps.
This instrument adopts the blades of Simpson's and Murphy's
instruments, and the elbow in the male blade of Simpson's. The
blades, by means of the elbow, are so regulated as to be perfectly
parallel when grasping the cranial bones and scalp, securing a
broad diffused hold, not liable to break away portions of skull.
The lock is the French forceps-lock, one blade being made to slip
easily into the other after separate adjustment to the head. At
the ends of the handles are holes to receive a screw, which serves
to approximate the handles and secure the grasp of the blades,
saving the labour of compressing by the hand, and leaving the
operator's strength at liberty for extraction. Figured in ' Ob-
stetrical Transactions,' vol. v, 1864. Specimens were exhibited
by Weiss and by Feeouson.
Dr. Hall Davis's Ceakiotomt Foeceps in general features
resembles Dr. Barnes's. The male blade has a range of teetli
forming a back serrated ridge in the shape of a very elongated
CRANIOTOMY FORCEPS— CEOTCHETS.
43
horseshoe. The female blade presents a corresponding groove ;
the blades are further fenestrated. The lock is Bruninghausen's.
Instead of Dr. Barnes's screw to fix the handles, a clip like a
rack is attached to the extremities. They are figured in the
subjoined sketch (fig. 39), as made by Coxeter.
Fig. 39.
CROTCHETS.
Dr. Eadfokd's Crotchet.
The length is 18-^ in. ; the blade with shank is 8^ in. long, the
shank being 2 in., the screw part -I in. It is curved and flat, its
widest part being ^ in., and becomes round and thicker towards
the shank. The hook is nearly f in. long, and turned from the
general curve of the blade, and stands from it at its point about
fin. The wooden handle is separate, and also serves for the
blunt hook ; it is 3-^ in. long, and flat on the hook side. It has
a circular metallic end (1^ in.), which is hollow and threaded, to
receive the threaded male end of the blade, along one side of
which there is a groove, where is placed a small lever catch
M hich falls into a notch on the rim of the shank ; this steadies
and fixes the blade when screwed up. The advantages of this
instrument are that the blade is flat, and that it stands in a
curved direction from the shank. (See fig. 40.)
Fig. 40.
44.
CURETTES.
BIesuard's Double Ceotchet. Exhibited by Dr. Cory.
Tliis instrument was recommended hy Smellie, and is figured,
as applied to the child, in his work. It consists of two crotchets
which articulate by the English forceps-lock.
Dr. D. Dayis's Double Crotchet. Exhibited by Dr.
Kadeord.
Smellie's Crotchet, having a blunt hook 3it one end. Ex-
hibited by Dr. E-adford.
CURETTES.
There was no important feature of novelty in any of these in-
struments; indeed, the only actual novelty was the curette of
Dr. Marion Siraa, made by Messrs. Mayer and Meltzer, of which
a representation is given in the annexed figure (fig. 41) .
Fig. 41.
It consists of a triangular steel ring, at the end of a malleable
silver stem, fixed in an ebony handle. The edge of the steel riug
is sharp, and the malleable stem may be bent in any required
dii'ection, as seen in a, h.
Fig. 42.
The other varieties were the sheathed curette for the removal
of soft polypi (fig. 42), invented by Sir C. Locock : the well-known
CURETTES.
45
double curette of Recamier, the one, perhaps, most commonly usedj
which is represented in this sketch (fig. 43).
Fia. 43.
Also the no less well-known scoop of Sir James Simpson,
which is represented below (fig. 44).
Fig. 44.
46
DECAPITATOES AND SAW FORCEPS.
DECAPITATORS AND SAW FORCEPS.
Dr. D. Davis's Decapitatoe was exhibited by Dr. John
Hall Davis. This instrument was invented in the year 1825. It
is figured and described in the author's work on ' Obstetric Medi-
cine,' p. 1172. The " Gruarded Embryotomy Knife," as it was
first termed, consists of two parts, separable from each other,
at a common joint, like the forceps. One part is armed with a
knife diagonally attached to the shank. This is first applied to
one side of the neck. The other part is simply a guard, and
is placed on the other side. On drawing the instrument down,
the neck is cut through.
Another Decapitatob (Exhibitor unknown) consisted of a
strong flat steel rod, 11 inches long, having a sharply curved
extremity. The whole had the shape of a hook. The concave
side of the hook has a sharp cutting edge, the convex side is
smooth and blunt. The cutting edge is about li inches long ;
the extremity is shaped like a bird's beak. This instrument
has no handle, but it resembles one figured in Dr. D. Davis's
work, p. 1172, which Dr. Davis states to be like one described
by Celsus. Maker's name, Mathieu.
M. Mette exhibited a Decapitatoe Hook, with Movable
Conductor, for carrying a rope round the neck. — The instrument
consists of a handle and hollow stem, together 14 inches long.
The extremity of the stem is curved and forms about a third ojC a
circle. The instrument is hollow, and a strong wire passes up
the centre. This wire is pushed up by means of a button slid-
ing in the handle, and at its extremity there is a little knob
which closes the open end of the stem. The instrument is used
thus : — After being passed round the neck, the internal wire is
pushed upwards, and this projects the knob round and beyond
the other side of the neck. A loop of string can now be passed
round the knob, and on withdrawing the instrument a cord is
thus left round the neck. Together with the foregoing instru-
ment were exhibited four chains and wire ropes, intended to be
used in sawing through the neck.
The instrument above described was invented^ by .Professor
DECAPITATOES AND SAW POECEPS. 47
Heyerdahl, Pirst Physician to the Lying-in Hospital, Bergen,
in 1855. Ropes were at first used, but chains are now recom-
mended, the chain to be crossed in the operation, to avoid muti-
lation of the soft parts of the mother.
Eamsbotham's Decapitating Hook.
This instrument consists of a hooked knife, cutting on the
concave side, mounted on a powerful straight stem, terminating in
a handle. The hook is to be passed over the child's neck in
certain cases of arm presentation where it is not possible or
desirable to turn. The neck being severed, the trunk is delivered
first, the head separately afterwards. Exhibited by Dr. Eadfoed.
Dr. Dayid Dayis's Gtjabded Decapitatob. Exhibited by
Dr. Hall Davis. (See ' Operative Midwifery,' 1825.)
Mathieu's Gttaeded Decapitatob.
This is essentially Eamsbotham's hooked knife, but it is in-
geniously sheathed daring application by a running jointed
sheath, which can be drawn back so as to bare the cutting edge
when adjusted. Exhibited by Mathiett.
Jacquemieb's Embbyotome (Decapitatob).
This is a concealed or sheathed decapitator, in general form
like Eamsbotham's hooked knife. The cutting is, however,
effected by movable blades and saw-links. It has — 1st, a blunt
crotchet, hollowed throughout its length along its concavity by a
groove or canal ; 2ndly, a handle fixed by a screw, sliding easily
in the groove of the crotchet, and terminating in a series of
jointed blades, whose convexity projects beyond the groove of the
crotchet ; 3rdly, a second stem, which can, without displacing the
crotchet, replace the first stem, and carries, instead of the convex
blades, saw-links ; 4thly, a movable sheath, which can slide up as
far as the springing of the curve of the crotchet, and which serves
to protect the soft parts of the mother during introduction.
Either the cutting blades or the chain-saw can be worked back-
wards and forwards.
This instrument can be used to divide the trunk as well as the
neck. Exhibited by Mathietj. Figured in Mathieu's Catalogue.
Decapitatin& Scissobs of Dr. Hall Davis. Exhibited by
Dr. Hall Davis.
Dubois' Decapitating Scissobs. This instrument is curved.
Exhibited by Lueb, of Paris.
Dr. Eastlake's Embbtotomy Scissobs. Dr. Eastlake has
48
DECAPITATORS AND SAW FOECEPS.
two pairs. One is curved on the flat, the other has a lateral
curve. Exhibited hy Ma.tee and Meltzee. They are designed,
not only to cut across the cervical vertebrae, but also to divide
other parts of the body.
Mattei's Endotome is a powerful instrument working on a
Bcissors-joint ; the shanks are double curved, so that by approxi-
mating the handles the curved blades can be brought together.
This instrument serves well for decapitating and for dividing
other parts of the body. Exhibited by Dr. Mattel
Van Hueyel's Chain-Saw Poiiceps (" Porceps-scie ").
This instrument is the invention of Professor Yan Huevel, of
Brussels. His original memoir describing the instrument is
dated 1842. It is intended to be used in cases where craniotomy
is necessary, and by its means the head is sawn through at the
part presenting, the head having been previously seized by the
forceps. An extremely ingenious contrivance enables the opera-
tor to introduce and apply the chain-saw after the blades of the
forceps have been applied.
The original instrument, a copy of which was exhibited by
Messrs. Weiss, of the Strand, and is depicted in this woodcut
(fig. 45), consists of a very strong pair of forceps, having a shape
Fio. 45.
closely approximating Levret's forceps ; the blades are very firm
and much thicker than those of the ordinary forceps. The length
of the whole instrument is 23^ inches, the distance from the hinge
to the extremity of the blades is 13 inches. Each blade of the
forceps has on its inner aspect a groove, extending from about
1 inch from the extremity to near the joint. This groove is
DECAPITATOES AND SAW FOECEPS. 49
so shaped that it allows a band of steel 15 inches long and f'oths
of an inch broad to traverse it. The band of steel is smooth on
one border and dentated on the other, and the chain-saw, next to
be described, works on the extremity of the band of steel as round
a puUey.
The chain-saw is 44| inches in length ; the links are small ; the
chain is smooth on one side and jagged on the other. It is pro-
vided with two small handles, and by means of these handles it is
worked.
Another part of the instrument is an apparatus for pushing the
steel band or chain-carrier up the grooves in the forceps. Just
below the joint there are two projections, which are perforated, so
as to allow of the passage of a small fluted roller. This fluted
roller is turned round by a long rod and handle as shown in the
engraving, and the rotation of this roller propels the chain-carrier
with the chain-saw up the grooves in the forceps, the teeth of the
chain-carrier corresponding to the grooves in the roller just
described.
To use the instrument, the forceps are first applied in the usual
way. The chain-saw is next introduced, a long loop of the chain
being left hanging down, as shown in the drawing. "When the
chain-carrier has been pushed home, it is there held fixed, and the
chain-saw is brought into action. The effect is that the scalp and
bones of the skull are sawn through up to a line passing horizon-
tally across from one blade to the other. During this part of the
operation the blades of the forceps are maintained closely applied
to the head.
The advantages claimed for the instrument are that it accom-
plishes more completely, more readily, more safely, and more cer-
tainly, the reduction of the bulk of the head in cases of obstructed
labour, than can be effected by the ordinary method of craniotomy.
The safety of the operation by this instrument, as compared with
that of other perforating instruments, is particularly insisted on
by its advocates. The head, being firmly held, cannot slip during
the operation.
CiiAiN-SAW FoECEPS OF Van Huevel, modified by Professor
Faye and M. Mette, of Christiania.
This instrument dates 1855. Two instruments were exhibited,
one having the pelvic curve, as in Levret's forceps, one straight.
1. The straight instrument measures — total length, 15^
4
50
DEOAPITATORS AND SAW FOECEPS.
inches ; length of blades, 8^ inches ; length of chain-saw, 3G
inches.
2. The curved instrument has a total length of 16 inches ;
length of blade, 8^- inches ; breadth of blades. If inch.
These instruments dift'er from Van Huevel's in this particular,
that the chain-carrier and groove are dispensed with. Between
the fenestra of the blades, 2 inches from the extremity, passes
across a flat bar of steel, in which is a small pulley, and round
this pulley the chain works. In using these instruments of
Faye and Mette, therefore, the chain-saw is introduced at the
same time as the blades of the forceps. Exhibited by M.
Mette, of Christiania.
Chain-saw Foeceps, by Billt, exhibited by Professor Laz-
zATTi, of Milan.
This instrument is smaller than Van Huevel's original. It
differs also from Van Huevel's in the mechanism by which the
chain-saw-carrier is introduced.
Total length is 18^ inches ; distance from joint to extremity of
blades, 10^ inches ; greatest width of blades 1\ inch ; greatest
thickness, \ inch ; length of chain-saw, 30 inches.
Fia. 46.
F
The mechanism for introducing the chain-carrier will be evident
from the woodcut (fig. 46). f is a separate and independent handle,
having a fluted extremity (g). This fluted extremity is inserted
through a perforation in the pivot c, and thus can be made to
act on the teeth of the chain-carriers r. Exhibited by Pro-
fessor Lazzati. Maker, D. Genuari, Milan.
DENTISCOPE.
51
DENTISCOPE.
Mr. Francis L. "West, of Coekspur Street, exhibited Mr.
Rhan's Patent Dentiscope, Laeyngoscope, Light-intensify -
[NG AND CoNCBNTEATiNG APPARATUS, for general, surgical, and
other operations.
This instrument is constructed for the purpose of illuminating
the inside of the mouth with a concentrated and intensified light,
for dental or surgical operations. It is represented in fig. 47.
It consists of an optical arrangement of lenses in a cone
and tube, with a rack-and-pinion adjustment for focussing.
This is mounted upon a plate, which moves in dovetails upon a
larger plate, that forms a screen, with racks and pinions to raise
Fig. 47.
52
DILATORS.
and lower the optical arrangement at pleasure. The screen
is jointed to a massive foot or stand, provided with a double-
threaded tangent screw, with a bold milled-head nut for adjust-
ing the screen to angles of elevation or depression.
At the back of the screen, and upon the foot or stand, is
fitted a branch pillar, carrying a Leslie's Patent Argand Gas-
burner, with stop-cock and connecting piece, to which may
be attached any length of india-rubber flexible gas tubing to com-
municate with any gas supply on the premises, or provided in a
portable india-rubber gas bag, to be placed in a suitable and con-
venient place for the performance of the operation.
The branch and pillar carrying the gas-burner is fitted also
with racks, pinions, and milled-head nuts, to adjust the flame
to the necessary distance and height required by the variable
position at which the optical arrangement may be required.
The whole of this structure is fitted upon a circular plate, with
centre cone or turntable — thus the instrument may be brought
instantly into any position required.
DILATORS.
1. Rectal.
Mr. Pratt exhibited Dr. F. Bird'.s .Rectum Dii.atou, which
is figured I'n the annexed sketch (fig. 48). It is a modification of
a similar instrument made for the male urethra. The engraving
Fig. 48.
shows its peculiarity in being curved, and having a short dilating
part which is intended to pass within the sphincter ani. Dila-
tation is accomplished by screwing or unscrewing tlie flat portion
of the handle. It requires care in withdrawal, and it is recom-
mended to close the blades on a couple of pieces of cork, whicli,
protruding beyond the sphincter, avoids all danger.
DILATOKS.
53
2. Ueethbal.
Dr. lioLith and M. Harden, of Paris, exhibited Dilaxohs fou
THE Female TJEETnEA, the latter of which was three-bladed,
and resembled at first sight a pair of tweezers ; but on com-
pressing the handles, which were kept apart by a spring, the
three small blades diverged in opposite directions.
3. Uteeine.
Of uterine dilators there were a great
variety, the differences having reference
chiefly to three points — first, as to the end
of the instrument, whether the two blades
should be united or not ; secondly, as to the
existence or non-existence of supports to
strengthen the instrument when opened;
and thirdly, as to whether there should be
merely a single joint at the extreme end of
the instrument, or, in addition to that, one
on either side about three eighths of an inch
from the end. It is obvious that in the
former case the instrument, when opened,
forms a kind of ellipse, while in the latter
case the blades separate more or less parallel
with one another.
The instrument invented and used by Dr.
Eigby in the year 18-10, and exhibited by
Ferguson (fig. 49), is a large and powerful in-
strument, the blades not being jointed at the
end, but separating in their entire length, the
separation being efi'ected by a screw process
at the handle. The instrument was not only
longer, but very much larger, than the uterine
sound.
Fig. 49.
54
Fig. 50.
DILATORS.
Dr. Protheroe Smith's instrument some-
what resembled Dr. Eigby's, but it dif-
fered in that at about an inch and a
half from the end there was a some-
what abrupt curve, so that it resembled
an ordinary lithotrite. It also was larger
and heavier than the ordinary uterine sound,
and was opened by a similar screw process.
It is shown in the annexed engraving.
Mr. Ellis's instrument acts on precisely
the same principle as Dr. Eigby's ; the two
blades separating in their entire length, but it
differs widely in construction from both the
former. This dilator was described as invented
in 1860, and was stated by the inventor to be
the first made of the exact form of the uterine
sound. The value of separating the blades,
Mr. Ellis thinks, is twofold — first, they exert
their chief dilating power over the internal
OS ; and secondly, that the instrument can
be easily cleansed of blood and mucus.
Being the exact size and shape of the ute-
rine sound, it can be readily introduced.
Protheroe Smith's
Dilator for the Os
Uteri.
DILATOES.
Dr. Priestley's Dilatoh resembles
Mr. Ellis's in the fact that it is of
the same size and shape as the
uterine sound. It differs, however, in
this particular that, while the blades
separate, their extremities remain
xinited, so that they form a sort of
elliptical opening. All these points
are illustrated in the annexed sketches.
A shows the blades separated ; at b is
a little indicator showing the extent to
which the blades are opened, while c
is the screw by which the process is
accomplished. The instrument is repre-
sented about half the actual size.
56
DILATOES.
Fio. 52.
Drs. Greeuhalgh and Hemborough have introduced instru-
ments which are modifications of the latter. In
them the ends of the blades remain united ; but
they differ from Dr. Priestley's in being jointed,
and that not at the extreme end only, but at a
short distance from the end ; so that, as the blades
separate, the latter joints admit of expansion
in almost a parallel direction. Much greater
strength and dilating power is given to the instru-
ment by the third or central rod, which passes down
its middle, and is the means of, as it were, pulling
open the blades.
Dr.Hemborough's instrument is here represented
open (fig. 52). It has three joints — a central (b),
and two lateral (a and c). To the centre one (b)
is attached a rod (d), which is included within
the two halves when the instrument is closed.
By shortening the rod d dilatation is accom-
plished to the extent required by turning the
screw-handle.
Dr. W. Bryant exhibited a Case of six Uteuine
Dtlatoes, all of which fitted on to one handle.
Dr. Savage's DiLATOB consisted of a double-action
instrument, acting like Smellie's scissors. A rack
at the handle, marked and graduated, regulates
the extent of divergence of the blades. "When
used for dilating the isthmus (inner os ?) uteri, the
blades act by simple divergence to the extent pre-
viously set at the rack.- For the remainder the
instmment cuts its way out by a combined pres-
sure and action of withdrawal performed by the
hand.
The instrument was invented by the author
for the more certain and safe dilatation of the
isthmus, as well as that of the rest of the canal
and outer os.
Dr. Marion Sims' Cebtical Dilatok consists
of two blades joined at their distal exti'emities, like the dilators
of Priestley and otliers ; a joint exists in each blade about half an
inch from the extremity. The instrument works much like an
DILATOES.
57
ordinary pair of tenaculum forceps ; by compressing tlie handles
the blades open, and by a graduated rack-work fixed in the
handles the amount of dilatation can be read off.
M. Mattliieu's TTteeine Dilator embodies the same principle
of action as those of Drs. Greenhalgh and Hemborough ; but
while they opened, as it were, bilaterally, this opened antero-
posteriorly, on the face of the curve as it were, as may be seen in
this di-awing (fig. 53). There are two joints at the end, which
Fig. 53.
admit of the upper portion riding over the lower, by means of
the little cross-bars, while the screw at the handle regulates the
degree of riding, and therefore of dilatation.
4. VAGINAIi.
VAGmAL DiLATOES OB Plttgs for arresting uterine haemor-
rhage.
M. Stille, of Stockholm, exhibited aUTEEiNE Plug, which con-
sists of an india-rubber ball, having a flexible tube attached to
it, and a firm cylindrical tube passing through its centre. One
extremity of this central tube ends on the further surface of the
ball, and the other terminates some 7 or 8 inches behind it, and is
provided with a stop-cock. The object of this tube is to give evi-
dence of bleeding without having to remove the plug. The other
flexible tube is to conduct fluid or air into the ball, which becomes
distended to the required extent.
Professor BuAtnN's, of Vienna, consists of a ball fastened at
one extremity of a stiff tube, which at the other end is provided
with a stop-cock to retain the air or fluid after distension. It
may be useful in some cases, but it is not equal to M. Stille's.
Dr. Geeenhalgh's " Oeiginal Felt Expanding plug eoe
HiEMOEEHAGE" was exhibited by Peegtjson.
This consists of an elastic tube 12 to 16 inches long, terminating
in a bulbous extremity, which is covered or capped with felt or
58
DILATOES.
spongio-piline. It ia inflated by means of an air-syringe, and com-
pletely fills the vagina when distended. They arc made of various
sizes.
West's Vaginal Plug was exhibited by Feegusok. This
instrument consists of a large india-rubber ball, springing from a
curved stifi" tube, ending in a stop-cock. It has a ring close to the
stop-cock, by which it is kept or fastened in situ. It can be in-
flated by air or distended by water.
Messrs. Mayer and Meltzer exhibited Dr. Marion Sims' Gtlass
Vaginal Dilatoe, which is used by him for dilating the vagina
after his operation for vaginismus. It consists of a tube about
three inches long, as is represented in the annexed sketch (fig. 54),
Fig. 54.
slightly conical and closed at one end, open at the other, about
an inch and a quarter in diameter at its largest part. There is a
depression or sulcus on its upper side for the urethra and neck of
the bladder. The outer open end allows the pressure of the
atmosphere to assist in retaining it easily in the vagina.
Dr. Marion Sims also uses another form of Vaginal Dilatok,
Fia. 55.
which is represented in this sketch (fig. 55). The downward
curvature of the conical extremity prevents it from striking
against and hurting the uterus, and it more cff'eetually prosscp
DOUCHES. 59
in the direction of the fourchette and perineum, when that is
necessary.
DOUCHES.
The Self-acting Douche of Messrs. "Weiss is represented in
the annexed drawing (fig. 56). It consists of an ordinary bidet,
Fig. 56.
standing upon four legs ; the vessel is filled with water, and the lid
raised thereby, as represented in the sketch, an elastic tube and
mouthpiece attached being fixed to the vessel containing the
water. The patient then introduces the mouthpiece, and sits
upon the lid, the vagina being over the open empty pan. The
weight of the patient forces the water from the reservoir just as
it would do the air from a pair of inflated bellows, the fluid
flowing in one continuous stream. This apparatus is therefore
easy of application, as it is strictly " self-acting."
Professor Lazarewitch exhibited his Appabattis fob the me-
thodical EMPLOTMEKT OP THE Uteiune Dottche. " It is repre-
sented in the subjoined sketch (fig. 57). It consists of a cylindrical
vessel, in the bottom of which is an opening covered with a per-
00
DOUCHES.
foratcd metallic plate to prevent the passage of any insoluble
materials in the water. In connection with that plate is a metallic
pipe, which passes under the double bottom of the apparatus. To
the end of that pipe a long elastic tube is fixed, furnished with a
Fig. 57.
A/
zinc curved mouthpiece, the point of which is oval and perforated.
A brass cock exists at the end of the clastic tube. In front of
DOUCHES.
61
the apparatus, in tbe trough-lilte cavity, is placed a glass cylinder,
which communicates below with the cavity of the vessel. When
in use the water passes from the vessel into the glass cylinder at
an equal height, and thus we may measure the height of the water
in the vessel. In the aforesaid glass cylinder is fixed a thermo-
meter, to register the temperature of the water.
The author claims for this instrument the following advan-
tages :
1. The water passes out of the tube in a uniform uninterrupted
stream, in accordance with the laws of hydrostatics.
2. The strength of the stream may be regulated ad libitum by
the height at which the vessel is placed.
3. The quantity of fluid used for the douche may be settled by
the direction of the physician.
4. The temperature of the water is easily determined by the
thermometer which is placed in the glass syringe.
Messrs. Maw& Son exhibited Savory's Vaginal DoucnE, which
is figured in the annexed sketch. It is exceedingly portable, and
Fig. 58.
easy of application. As may be seen, there is an elastic bag or
bottle which is to be filled with the fluid to be injected ; to this
is attached the elastic hand sjringe, and an india-rubber tube
and mouthpiece complete the arrangement.
The same makers exhibited the Ieeigatetjb of Dr. Equisier,
which is made on the self-acting principle, and may be used for
enemas as well. The plug in the barrel of the instrument, being
fdled with the fluid to be ejected, is wound up by the handle at
the top, and, the mouthpiece being inserted, the fluid is then
ejected by the force of a spring, which runs down, as it were, like
02 DOUCHES.
a clock. The instrument is shown in the adjoining illustration
(fig. 59).
The Portable Uteeine Douche exhibited by Messrs. "Weiss and
Son is a very useful instrument.
It is constructed of caoutchouc,
and is easy and simple in its
mode of employment.
Dr. Eascli's Vaginai, oe Ute-
EiNE Douche, which is repre-
sented in the annexed drawing
(fig. 60), consists of a long india-
rubber tube from 6 to 7 feet long,
and as thick as the little finger,
made heavy at one end with a
hollow bell-shaped lead, the base
of which has largo grooves to
allow the entrance of the fluid
from the very bottom of the
vessel. An elastic thick bougie,
with several holes in the bulbous
end, and not less than 5 inches
long, is fastened at the other end
of the hole.
To use the instrument, com-
pleteJy immerse about 2 feet of
DOUCHES.
63
the tube along with the metallic end iu the fluid, then compress
the tube, beloio the fluid, with the thumb and forefinger, and
draw it out over the brim of the vessel. By this means the
filled tube is brought lower than the surface of the fluid in the
vessel (which must be placed as high as possible, on some piece of
furniture), and after removing the fingers a constant stream will
be established. The other end is for insertion into the part to
be injected. The patient sitting over a basin on the floor will
prevent all splashing about of the fluid.
To use the instrument for applying a clyster the same manipu-
lation is required. A pint of warm water and some oil will have
the desired efiect. The instrument is made by E. Lewis, Chemist,
31, City Eoad, Finsbury Square, E.C.
Dr. Sansom's Uterine and VAaiNAL Dotjche is constructed so
as to apply an uninterrupted stream of fluid to the uterus or vagina,
and thus to spare the necessity of the frequent removal and re-
introduction of a vaginal tube. The effect of an uninterrupted
stream, the author thinks, is of the highest importance. Dr.
Sansom has succeeded in the course of a few minutes in dilating
the 08 uteri by a stream of water projected against it ; and by
supplying patients suflfering from the less chronic conditions of
retroversion of the uterus with a vaginal pipe so constructed as
to allow the jet to impinge upon the displaced fundus, and in-
structing them to use the douche at frequent intervals, he has
found that the organ has tended to regain its normal position.
The instrument consists of a closed india-rubber bag, capable
of holding three pints of water. From its inferior portion passes
Fig. 61.
a long tube, ending in a vaginal pipe. To fill the bag, place the
vaginal pipe in water, and roll up the bag so as to expel all the
air it may contain ; place the emptied bag on a low level — the
61
DOUCHES.
floor, for example — then, the tube becoming a syphon, the bag soon
fills. Of course, any lotion may be used instead of water. The
bag being filled, it is to be hung up by its loop at a height pro-
portionate to the force of the stream desired. The patient then
introduces the vaginal pipe, and controls the stream by the tap.
The instrument is represented in this sketch (fig. 61).
It is made by Messrs. Francis, of No. 2, Upper Street,
Islington.
ECEASEUES.
65
ECRASEURS.
Of these instruraeuts a considerable number were exhibited,
showing a great variety in form, mode of working, and in the
material used as the cutting part : some having a screw power,
others the click-clack movement ; two working at right angles to
the line of division; some having chain, others wire rope or a
single wire, and others watch-spring.
Mr. Spekcee "Wells exhibited one invented by him in the
year 1858. It was 12 inches long, working with a screw, having
three arras in the handle. The eye of the instrument expanded
to I inch, being i inch thick. Inside the eye are two metal
rollers to lessen the friction of the wire or cord when in use.
The edges of the eye inside are sharp, so that its action is neces-
sarily more or less in a line with the shaft, otherwise the wire or
cord would be cut through. It was made by Savigny (now
Whicker and Blaise), vide ' Medical Times and G-azette,' May 7th,
1859.
CHASSAiaNAc's Chadt Eceaseub, with click-clack movement
and straight shaft, was exhibited by Ferguson and Dueeoch,
A similar instrument, with curved shaft, was exhibited by
Feegxtson.
Dr. Haake, of Leipzig, exhibited a Chain Eceasetje, in which
the shaft of the instrument was straight, carrying a screw which
coiled up the chain on its upper part in a downward direction, bo
that the line of section was at right angles to the shank. To
lessen the amount of torsion of the shaft, the arms of the screw-
handle are placed about the middle of the instrument, the lower
half being the handle whereby to steady it. The instrument is
represented in the adjoining sketch (fig. 62).
Fig. 62.
5
66
ECEASEURS.
Mr. Hilliaud, of Grlasgow, exhibited an instrument, made
by himself, of a similar description, but coiling up the chain in
an upward direction, i. e. towards the extreme end. Instead of
the arms of the screw-handle being in the middle, they were at
the end of the shank.
Dr. J. Braxton Hicks exhibited an Annealed Steel-wiue
Rope Eceaseue (fig. 63), made by Durroch, of various sizes.
The large size (fig. 1) consists of a shaft about 15 inches long,
fitted with screw power, having three arms to handle, and a
traversing hook to which one end of the wire rope is fastened.
The eye is oval, having the edges everywhere carefully rounded,
so as not to cut the rope, even if at a considerable angle to
the shaft. The eye is also placed at a slight angle to the
shaft, to the side on which the hook is placed ; so that it forms
altogether a considerable curve on which the rope bears while in
use; the instrument can thus be used in any position within
the vagina and uterus. There is a cross-bar at lower end of shaft
to which to fix the rope after adaptation. Any sized rope can be
used: for the largest, one made of 60 or 70 strands of carefully
but not too fully annealed steel wire is required for the removal
of the cervix uteri and the larger polypi. The rope should not
be twisted too tightly nor made too neatly, for roughness adds
much to the cutting power. The rope in all cases should be made
up of secondary ropes of 5 or 6 strands in each ; even made of
80 strands it is still very flexible. In cases of intra-uterine
polypi, or in those where they are of great size although in
vagina, canulse (fig. 3) with handles are added, through which a
small rope of 2 or 3 strands is passed up and down, so as to leave
a small loop at the end. Through this loop the wire rope is
passed, and by means of two or three of these it is carried round
the polypus. The rope should be separated from the ecraseur
if only two canulfB are used ; and one should be made to hold the
rope tightly, while the loop of the other should run easily over it,
so as to carry it roimd the polypus freely. The ends of the rope
are then passed through the eye of the ecraseur, which is pushed
up to the neck of the growth ; after which the ends are fastened,
one to the hook, the other to the cross-bar. The cauula? are no\^
to be removed by pulling down one end of the wire loop till it is
free from the rope. These instruments can be made of various
sizes, or with movable heads of various sizes.
ECEASEUES.
Fia. 63.
67
68
ECEASEURS.
A small instrument (fig. 2) was also exhibited by tbe inventor
for a rope of 2 to 3 strands, for removing small vascular outgrowtbs
of cervix uteri, &c., tbrougb the speculum. Tbe book sbould be
broad wbere tbe bearing of tbe wire rope occurs. Tbe inventor
prefers baving two books back to back, over wbicb tbe rope is
fastened like tbe figure 8. By tbis arrangement tbe rope can be
refastened : wben, in cutting tbrougb any large tumour, tbe book
comes to the end of the shank without baving completed the
severance, the rope can be unfastened, the book screwed up to
the upper end again, and the rope refastened to it.
Tbe drawings are about half the natural size.
Specimens of the same instrument were also exliibited by
KHEOinE and by Coxeteb.
Eopes were also exhibited by Mette, of Christiana, for similar
purposes, having a core of stout catgut, over which was plaited
small iron wire, and some of stouter wire than usual, which ren-
dered it not so flexible.
There was also an instrument which bad, instead of a flexible
rope or chain, a series of 3 or 4 watch-springs bent in the form
of a hoop, which, passing through the eye of the ecraseur, was
fastened to tbe traversing book. The power employed was that
of the screw. The edges of the eye were sharp, and the line of
section was continuous with the axis of the shaft, the inflexibility
of tbe springs laterally not permitting any further adaptation.
It is an instrument, therefore, more adapted to external than
internal use. The loop, evidently, was one of great tenacity.
M. StiI/Le, of Stockholm, exhibited a small ecraseur, which
was worked by a screw, moved by a sliding bar to give increased
leverage. The shaft was curved towards the end, so as to bring
the line of section at an angle to the shaft ; while the stout
copper wire which was employed instead of a chain, &c., worked,
as it were, in a groove formed by tbe curved shaft. It was
altogether 9 inches long. Both ends of tbe wire were attached
to the hook, coming down simultaneously wben in use.
One nearly similar was shown by Dureooh, of French make,
but tbe shaft was straight.
ECEASEUES.
69
Fig. 64.
Messrs. Weiss exhibited
an EcEASEtJB fitted with
two screws side by side,
to each of which a hook
was attached : these screws
were worked by a shifting
handle, so that the sides
could be worked alternately
by changing the handle
from one screw to the
other. This instrument is
represented in the annexed
illustration. Besides this,
it was made with various
heads ; so that either the
chain, with a suitable eye,
or the wire rope of various
sizes, with three heads and
eyes proper for the rope,
could be employed at
pleasure.
70
ECEASEURS.
Dr. Mabion Sims exhibited a Chain Echasetje, to which he
had adapted an apparatus which had for its object the keeping
open the loop of the chain during application round a polypus.
This was effected by means of a spring of two blades (ce), parallel
when closed, separating at the extreme ends (//") ; with an ar-
rangement by which it not only can be opened when required,
but also removed when the chain is properly applied. The double
spring is placed inside the chain-loop ; after it is passed into the
vagina, the blades are expanded (as in fig. 2) ; the loop is then
Fia. 65.
Fig. I. Fig. 2.
ELECTEO-MA&NETIC COIL.
71
passed within the cervix, and the polypus surrounded by it. "When
this is accomplished, the spring is withdrawn, leaving the chain
only round the growth, which is then divided in the usual manner.
To prevent the chain from slipping off the blades of the spring,
smaU loops (as at ff, fig. 1) are placed on the lower edge of the
spring on which the chain rests.
This instrument was made by Messrs. Mayer and Meltzer.
Professor Keassovskt exhibited, through Professor Hugen-
berger, his Eceasexje, part of which is also used as a clamp in
ovariotomy, the instrument being divisible in two parts (as seen
in the drawing). It is made on the principle of Charriere's
Fig. 66.
ecraseur, and consists of two parts, a chain and screw. The part
with the chain is used for compressing the pedicle of the cyst ;
the small screw a, with a key for fixing the chain on any spot
as occasion may require. The back surface of this part, covered
with ivory, comes in contact with the patient's skin, while the
metallic portion is applied outside. After compressing the pedicle,
this part of the clamp is retained in that position, so that neither
branch may fall into the wound. The part with the screw forms
part of Charriere's ecraseur. At present the Professor uses a hot
wire to the pedicle of the cyst.
ELECTRO-MAGNETIC COIL.
Mr. W. Ladd exhibited an Electuo-maonetic Coil, for
medical purposes.
This apparatus, which is represented in the annexed illustration
(fig. 07), forms a perfect electro-magnetic battery. When closed
it resembles a book with a clasp, and can be carried in the hand
or under the arm. Upon unclasping and opening it, will be
found a small tray, containing the conductors, wires, bottles of
72 ELECTEO-MAGNETIC COIL.
the exciting salt, &c. On the right of the tray is the vibrating
spring, poles, &c.
Fig. 67.
On the left of the book is a small door, which upon being
opened exposes the sulphate of mercury battery, which is chosen
from its extreme cleanliness and high electro-motive force. The
tray is made of ebonite ; within this is a cell of carbon, cut out
of the solid block ; this is lined with a piece of cloth or lint, and
upon this is placed a slab of zinc, a piece of which is bent up
and faced with platinum. There is also a copper connecting-
piece for the carbon-cell.
To excite the battery, place sufficient sulphate of mercury salt
on the carbon tray to cover it over and make an even surface ;
the lint is placed above this and left sufficiently large to turn up
at the sides, so as to prevent contact between the zinc and carbon ;
about a teaspoonful of water is then poured on it, and the zinc
plate placed upon the lint. The tray must then be put back into
the box and closed. The battery is now in circuit with the
primary wire of the coil. The spring must be adjusted by the
eccentric button, which should be geutly turned round until tlie
vibrations show that the battery is iu action ; by turning the
button back a little the vibrations are diminished in frequency.
On either side of the vibrating spring will be perceived two nuts
ENEMA APPARATUS.
73
with holes through them, those on the left marked P + and p — ,
those on the right s + and s — : p + means the positive pole of
the primary wire, p — the negative pole of the primary wire : s +
signifies the positive pole of the secondary or finer wire, s — the
negative pole of the same wire. If we wish to use a very gentle
current, the copper pegs of the conducting-wires are inserted
into P + and p — respectively, and upon holding the conductors
in the hands a hardly perceptible current is experienced; to
increase this, the brass handle in front of the box to the right of
the clasp is gradually drawn out, and the soft iron core contained
in the centre of the coils is gradually exposed and magnetized, in-
creasing the strength of the transmitted current ; push back the
brass tube, and insert the pegs of the conducting wires into the
nuts, s + and s — , and we get the current from the secondary
wire, which is much more powerful than that from the primary
wire. Now gradually draw out the brass tube, and the current
becomes by degrees so powerful as to be unbearable. With this
little battery any requisiie power can be obtained. If it is in
regiilar daily use, the carbon-cell will have to be cleansed about
once a week ; the lint should be taken out and well washed, so as
to remove all the yellow deposit ; then rinse out the carbon-cell
with fresh water and wash the under surface of the zinc;
replace the lint, and the battery is now ready to be re-excited.
The process of cleansing need not take more than two or three
minutes, and is only necessary about once a week.
ENEMA APPARATUS.
Mr. Salt exhibited a Poetable Enema Apparatus, without
detached parts, which is illustrated in the annexed sketch (fig. 68).
Fig. 68.
It is certified by the leading practitioners in Birmingham as
being simple in construction, facile in use, and in every way fitted
for the purpose for which it was invented.
74
EEEDING BOTTLES— rOECEPS.
FEEDING BOTTLES.
Mr. CooPEU, Chemist, Oxford Street, London, exhibited an
appliance which lie calls the Bkitish Ejeeding Bottle foe
MEOULATiNG TUE SUPPLY OP EooD POE Inpants, the principal
merits of which appear to be, that it is very easily cleaned ; the
supply of food is regulated by an electro-plated stop-cork ; the
admission of air into the stomach is prevented; the teat is of
very soft enamelled india-rubber, finely perforated to imitate the
nipple, which can be instantaneously removed, washed, and wiped
dry.
The same maker showed a very convenient Invalid Glass
roH Deinking while Eeclining.
FORCEPS.
I. MiDWIPEUY.
No better evidence of the value of the forceps as an obstetric in-
strument could be adduced than was afforded by the number of
the specimens exhibited, the celebrity of the inventors, and by the
amount of ingenuity displayed in the various and ingenious modi-
fications to meet the ordinary difficulties and special peculiarities
of individual cases. In drawing up this report, great care has
been taken to secure accuracy of detail upon all essential points,
either by correspondence with the inventors themselves or with
the instrument makers who were employed by the inventors. In
one case only was tbe information supplied by an instrument
maker imperfect, as will be seen by the accompanying table.
76
BRITISH FORCEPS.
BRITISH
0 lock.
c >
" t
e
OD
u
i
No.
Date.
Inventor.
Exhibitor.
jf forceps
)f blade t
)f blade ti
nent of c
)f fenestn
of blade.
ice of api
M
60
P
t
a>
^ 53
"S) §
g a
to
p
M
^3
tu
u
o
bo
(4
>
OJ
>^
P3
1
Barnes
Weiss
15
9f
61
4*
2
1
2
1842
Beatty, T. E.
Beatty, T. E.
12i
8
7i
5i
8
8
3
Bird, Fred.
Pratt
14
9
of
3f
2
3
4
4
Blundell
Weiss
14
81
61
41
If
■**4
8
5
1751
Burton
Cory
1 O 1
4t
44
Q 1
^4
nil
b
Iboo
C h amb erlen
HQ '•'/"Ml □ /^T»
Jj ©rguooii
7(
1-5
l-6i
1.
1
7
Ditto
Ditto
Q
O
7
K
-••4
-•■8
Q
O
PVniT-/^ Villi
VV tJloo
14i
8i
6i
4i
1
9
fJnlUna
Coxeter
lOi
5f
3i
-■-4
1
10
(^nTinnPst
Durroch
13i
71
7
5i
2
\
11
Davis, David
121
6i
7
5i
\
12
Ditto
Ditto
12i
8i
n
5i
11
3
4
13
Ditto
Ditto 1
14f
12
lOi
4
nil
3*
2
1
14
Ditto
Ditto 1
Hi
10
5
4
4
2i-
4
15
Ditto
Ditto 1
Hi
10
7
5i
5
4
4
21-
4
BEITISH FORCEPS.
77
IFORCEPS.
0
be
? i
2-1
2i
3|
3
3
2i
27
^5
21
2i
u
2i
Straight
Ditto
Ditto
Ditto
Ditto
Ditto
7
s
Straight
Ditto
Curved
Form of lock.
Ordinary shank
ring
Ordinary
Ordinary shank
ring
Ordinary
Eack and pinion
Hole for tape
Ditto
Ordinary
Ditto
Ordinary curv-
ed perineal
shanks
Ordinary shank
Ditto
Ditto
Ditto
Ditto
Form of handle.
"Wood, straight,
rough
Wood, straight,
smooth
Ivory, straight,
smooth
Wood, straight,
smooth
Steel bow
Iron bow
Ditto
Wood, straight,
indented
Wood, straight,
smooth
Wood, straight,
smooth, screw
handle
Wood, straight,
smooth
Ditto
Ditto
Ditto
Ditto
Bemarks.
Weight lOi oz. ; ' Dublin
Med. Journ.,' July, 1842.
Murphy, fig. 15.
Churchill, plate vi, figs.
6—9.
Murphy, fig. 1.
Murphy, fig. 17.
Murphy, fig. 6.
Murphy, fig. 5.
Churchill, plate xiii, figs
1—5.
78
BRITISH FOECEPS.
No.
Date.
Inventor.
Exhibitor.
Length of forceps.
Length of blade to lock.
t
0 ^
u ^
0 3
43 0
a> Cm
re! 0
? 0
a
(D w
Length of fenestrum.
Breadth of blade.
Divergence of apices.
16
1786
Denman
Weiss
11*
6i
6i
4i
I4
I
17
Duncan
Young
13
8^
6*
4*
11
7
8
18
1863
(rn vtnn
VjI m V LA-/ 1-1
Gayton
12
7i
7
4*
If
7
8
19
Giles
Giles
IH
7
7
J-ir
1
20
1839
Grreenhalgh
Weiss
11
6i
1 J.
-■-8
21
>>
Ditto
Ditto
lla
Si
a 1
O2
5
Ditto
Ditto
Id
0 2^
7
0
9
1
JL
23
Haighton
Durroch
II4
1
7
9_L
7
8
24
1775
Hamilton
Ditto
12i
7
61
14
7
S
25
Harper
Pratt
14
9
4*
2
-•-4
26
1861
Hewitt, G.
Weiss
13
8
8
5
U
1
3
27
Hopkins
Coxeter
12i
7*
4i
2i
7
28
1760
Jolinsou, W-.R.
Cory
Vl\
7*
7i
5*
If
.f
29
Lever
Coxeter
14
9f
6i
4i
3
4
30
Lowcler
Gory
lU
6
5f
4^
If
BEITISH FOECEPS
79
c
o
to
. !3
o
2^8
3
3
2f
21
3i
2f
21
2i
3
3
:3
Straiglit
Straight
Form of lock.
Straight
2*
3
Straight
Straight
2i
Straight
Ordinary
Ordinary, " very
easy "
Ordinary, one
side only
Ditto
Ordinary ring
Ditto
Ordinary shank
ring
Ordinary
Ditto
Ziegler's
Ordinary
Ordinary ring
Ordinary
Ordinary shank
ring
Ordinary
Form of handle.
Remarks.
Wood, straight,
smooth
"Wood, straight,
" conical digital
groove"
"Wood, straight,
smooth, spring
rack at extremity
"Wood, straight,
smooth, hinge in
handle
Ivory, straight,
rough, short
Ditto
Ivory, curved,
rough, short;
"Wood, straight,
smooth
"Wood, straight,
smooth, one to
turn back
Ivory, straight,
rough, finger
rests
Wood, straight,
rough
Wood, straight,
smooth
Ditto
Ditto
Ditto
Churchill, plate x, figs.
3, 4.
Murphy, fig. 13.
Murphy, fig. 18. .
Churchill, plate vii, figs.
9, 10.
80
BRITISH FORCEPS.
u
I
a .
o
1— 1
o
a
3
CO
u
No.
Date.
XLl V KjU. VXJl. ■
GO
p.
<a
a
Cm
O
Df blade
ment of (
tn
c
.-1
Cm
o
T3
C3
O
o
u
o
a>
O
B
bo
a
fcD
fl
<u
be 01
g a
tD
13
OS
<u
>
Hi
a
s
31
Meadows
Meadows
13i
8*
4i
1-3-
32
Murphy
Coxeter
12i
8
6
4
1
33
Oldham
"Weiss
13*
8i
c*
4
n
84
1825
Radford
Radford
141
9
^
5
35
Ditto
Ditto (
C
131
lOf
OA
•74
7i
Ri
5i
23,
■•-4
36
Ditto
r
Ditto ]
13*
13*
13
lOf
lOf
10
7^
'7 1
'4
6i
5^
8
54^
2i
■'J
24
8
oblique
37
Ramsbotham, F.
Ferguson
13
8i
6i
4i
1''
-■-8
1
38
Robertson
Robertson
14
7
7
4
1
39
Simpson
Young
13i
8
6*
4i
If
7
8
40
1752
Smellie
Cory
lU
6i
6i
4i
H
h
41
Walter
Durroch
14
8-J
6i
n
i
42
Ziegler
Weiss
13i
81
6^
44
H
1
BEITISH FOECEPS.
81
curve.
Form of lock.
Pelvic
Ordinary
Straight
OvniTinTV 5innr»l*
2
Ditto
1^
Ditto
Straight
Ordinary ring
V J. u.ijj.u>i y oiiUfiiiv
ring
1 7
H
Ordinary shank
Curved
Ordinarv
2
Ordinary Rha,Tik
Straight
Ordinary
Ditto
Ordinary shank
Ditto
One double
shank, one single
to slide into first
Form of handle.
Wood, straight,
smooth, finger
rests
Wood, straight,
rough
Wood, straight,
smooth, square
tops
Wood, straight,
smooth, short
Ditto
Wood, straight,
smooth
Wood, straight,
rough
Wood, straight,
smooth
Wood, straight,
indented finger
rests
Wood, straight,
smooth
Ditto
Ditto
Remarks.
Eamsbotham, * Obstet.
Med.,' 3rd ed., p. 282.
Shifting blades for pocket.
Murphy, fig. 14.
Churchill, plate vii, figs.
1— 4.
6
82
CONTINENTAL FOECEPS.
CONTINENTAL
in
:o lock.
;o com-
jurve.
g
s
1
TO
U
Pi
(U
<B
13
rrt O
hi
-*:>
O
"5,
C3
No.
Date.
Inventor.
Exhibitor.
u
cs
f bla(
nent ■
a
Cm
Cm
Cm
0
U
o
bo
a
mgth 0
o c
- I*
^ a
i3 8
O
t
a
e3
0
ivcrgen
^^
a>
k5
P
1
Assalini
Lollini
16
[8i
|6i
nU
11
2
Baudelocque
Eadford
18^
101
n
6
2i
X
4
3
Busch
Priestley
lU
• 2
6
3^
1^
J-*
.•}
4
CaniDbell
Charriere
16
2i
1
n
u
liiier
18
1
54
2i
b
vytJU.t;i o*-**-* J UiU.
9|
7
4
1^
-'■4
1
Tl
7
Charriere
Charriere
18
—
2
>
Q
O
Chassagny
Ditto
18
10
7
5
li
nil
9
Chassagny
10
Duse
Durroch
16
1 81
nil
1 ■
11
Faye
Liier
18
9i
51
2
12
•
Hardon
Hardon
13
Hennig
Henuig
IH
8i
2
14
Hoffmann
-II
CONTINENTAL FOECEPS.
83
))RCEPS.
£00
10)
Pelvic curve.
Form of lock.
Form of handle.
Bemarks.
■'4
113
!)
■■'4
!i
' ) 5
■ -"5
1 J 1
51
3i
2f
Straight
& curved
2i
2i
Curved
Tenon and
mortise
Button screw
Ordinary one
side
Button screw
Pivot
Ordinary one
side
Button screw
Ditto
Steel, lock at
lower extremity
Steel, bow, two
blunt hooks
"Wood, straight,
smooth, finger
rests
Wood, straight,
rough
Steel, blunt
hooks
"Wood, straight,
rough, finger
rests
Steel, blunt
hooks, shifting
handles
Black japanned, very
heavy.
Charriere's * Catalogue,*
p. 119, fig. ^4.
Ditto, p. 120, fig. 309.
• 1
Straight
u
Eaised button
screw
Pivot
Steel, blunt
hooks
Ditto
Churchill, plate iv, fig, 7.
2?-
Ordinary
Wood, straight,
smooth
84
CONTINENTAL FORCEPS.
No.
Tn vPTif.nf
^ 11 V IX vyJX. •
Exliibitoi*.
Length of forceps.
Length of blade to lock.
Length of blade to com-
mencement of curve.
Length of fenestrum.
Breadth of blade.
Divergence of Hpices.
15
Hiigenberger
Hiigenberger
13
8
54
44
li
u
16
Huevel, Yan
"Weiss
20i
10
10
3
Iff
17
Joerg
Hennig
13
7i
6
44
1-4
i
18
Krassovsky
Hiigenberger
16
9*
8i
54
9
19
Lazarewitcli
Lazarewitcli
13i
7f
44
2
i
20
Levret
Hiigenberger
151
8i
7i
54
2
91
JUtJ> Y
17
10
64
5
14
8
Lit
XjOVcII/1
18
9i
64
54
2
1
23
Martin
Liier
14
9
9
5
1|
i
24
Mattel
Mattel
11
9^
6
6
21
25
Ditto
Ditto
141
7
6
41
11
1
Mpsiiard
Cory
13
64
H
2^
27
Mondotte
Mondotte
11
10
6
54
2
28
Nsegele
Liier
15
8i
84
44
11
29
Nivet
Charriere
17
6
1
CONTINENTAL FOECEPS. '85
:«
Z3
Pelvic curve.
Form of lock.
Form of handle.
Remarks.
!3i
1}
) )3
•-4
1 )3
1 » 1
•■• a
2i
2i
2i
3
3i
3
3i
Ordinary
Slotted pivot
Ordinary one
side
Ditto
Tenon and
mortise
Button screw
Ordinary
Pivot shifting
"Wood, straight,
finger rests
Steel, straight,
fluted
"Wood, straight
"Wood, straight,
smooth, finger
rests
Steel, fluted,
rectangular ends
"Wood, straight,
smooth, extre-
mities tipped
•with iron
Wood, straight,
finger rests,
fold in handle,
folding blades
Steel, blunt
hooks
Chain saw in blades. See
Decapitators.
Churchill, plate ii, fijrs.
1—5.
i!^
' '4
''4
4^
Straight
2}
Hole in handle
SViifl-i'nrr
oniicmg
Sliding lock in
handle
Holes in handles
Wood, rough,
horizontal
Wood, rough
horizontal,
shanks parallel
Wood, straight,
smooth
Horizontal
Charriere's * Catalogue,'
p. 121.
Churchill, plate v, fig. 8.
3
r(
■ 4
3^
Pivot
Ditto
Wood, rough,
finger rests
Steel - guarded
crotchet and
perforator
I
86 CONTINENTAL FOECEPS.
I
g .
)f forcep.
o
o
o 3
s
cn
o
o
No.
Date.
Inventor.
Exhibitor.
)f blade i
)f blade
ment of (
jf fenesti
of blade.
ice of api
t
(3
:B
bD
a
a a
:2
to
B
d)
CS
iverger
3>
30
Pajot
Charriere
13i
8^
6i
41-
11
31
Eizzoli
Rizzoli
171
9
7
5
o
32
Eizzoli
Eizzoli
I7i
9i
7
5^
-•-4
1
33
Rizzoli
Eizzoli
161
8i
7
5i
n
34
Saxtorpli
Nyrop
16
9
6i
5f
X
4
35
Siebold
Hiigenberger
15
8i
7*
2i
If
i
3
36
1843
Talatani
Liier
lOi
7^
4
37
Trelat
Ditto
161
9^
7
4
2
CONTINENTAL FORCEPS.
87
I
;
i
!
!
Pelvic curve.
Form of lock.
Form of handle.
Eemarks.
Curved
Button screw
Blunt hooks
■j 1
i'4
ft
a
21
Ditto
Ditto
Ditto
Steel, curved
blunt hooks,
one at right
Steel, parallel,
oneblunthook,
one at right
angles
Steel, parallel
»i
.'2
)3
••-2
4
Ordinary-
Button screw
Wood, straight,
rough, folding
w oou, siraigni;,
smooth, ends
eyeriou
Churchill, plate ix, figs.
8, 9.
Used for 30 years by Rus-
sianDistrict Surgeons by
oruer oi rne ijtovern-
ment ; used by Eechter,
Sen., from 1790 to
1820.
2f
Pivot
it
2i
Ditto
Steel, rough,
bowed, trans-
Terse steel for
traction
88
FORCEPS— UNKNOWN.
FORCEPS-
bo lock.
to com-
lurvc.
a
DO
o
u
No.
Date.
Inventor.
Exhibitor.
)f forceps
3f blade 1
^ — w
13 O
^ -►^
-1
)f fenesti
of blade.
ice of api
be
B
c
o
sngth (
mencei
-3
tc
,£3
a
U
ivergei
o
>A
0)
1
1783
Unknown
Beatty, T. E.
11*
6*
6i
1
1
4
to
1831
2
1700
Ditto
Cory
7i
' 2
7*
5
li
nil
3
1752
Ditto
Cory
11*
64
6
X
4
Ditto
Durroch
17
8
7
U
8
5
Ditto
LolHni
19
lOi
8*
5
If
5
ir
6
Ditto
Merriman
7i
n
71
4i
H
u
7
Ditto
Smith, Tyler
17
' 8
5}
H
1
4
8
J apanese
Smith, Tyler
9i
4''
4
s
4
1
FOECEPS— UNKNOWN.
«9
«fKNOWN.
-3
u
o
*>
Form of lock.
m Straight
i2i
i2
22|
111
2i
Straight
Ditto
4,5
Straight
Ditto
Ditto
Form of handle.
Male and female
Ordinary
Ditto
Button screw
Ditto
Ordinary
Button screw
Square groove
Wood, straight
Ordinary
Ditto
Steel, 1 blunt
hook, 1 per-
forator
Wood, smooth,
finger rests
Iron, sharp rack
extremities
Iron, straight,
extremities
curved out
Remarks.
Churchill, plate xii, figs.
3, 4. " A slit in one
blade, just above the
handle, permits the
other blade to pass
through ; used in 125
cases by the late Dr.
Beatty."
90
rOECEPS.
Glancing tlirougli this table, in alphabetical order, the follow-
ing instruments appear to deserve some special notice,
Baenes's Eoeceps, — The inventor states "the ring formed by
the union of the blades gives advantage of additional grasp, so that
the two handles can be used together or alternately. The ring
virtually lengthens the handle. The parallel shanks further give
power by their length, and obviate all stretch on the peri-
nseum."
Dr. Beatty's SiEAiaHT FoBCEPS are remarkable for their
lightness, weighing only 11 oz., for the length of their blades,
and for the slenderness of the arms of the fenestra), which are
not rounded out internally, so that their strength is not impaired.
They were designed, described, and published by the inventor in
the ' Dublin Medical Journal,' vol. xxi, in 1842.
Dr. Fredeeick Bied's Foeceps are seen in this sketch (fig.
69) . They have unusually wide and rather short fenestrse, long
shanks, and a ring just above the handles, formed by the opposed
shanks, for the finger, to facilitate in the process of extraction.
Fig. 69.
Campbell's Steai&ht akd Cueveb Foeceps.— The peculiarity
of these instruments is, that they can be used either as short or
long forceps, by means of shanks which slide into the handles,
and can be firmly fixed to any length by a catch on the upper
and outer parts of each handle ; they may also be used as finger-
rests.
M. Chaeeieee's Jointed Foeceps.— The inventor and maker
states, " The method of dismounting these forceps is very simple
and solid, and permits also of the adaptation of the blades of
various forms and sizes without augmentation of volume. See
Charriere's Catalogue, p. 120, fig. 309.
Chassaqnt's Foeceps, with apparatus for sustained and gra-
dual traction and progressive compression.
POECEPS.
91
Chassagnt's small Pocket Poeoeps, for application wlien
the head is at the ioferior aperture of the pelvis.
Five pairs of Dr. D. Datis's Pobceps were exhibited by Dr.
J. Hall Datis.
Isf Fair. — Common short broad-bladed, with one short blade,
used in cases of prolapse of the funis.
2nd Fair. — Narrow-bladed, one used sometimes with broad
blade.
Zrd Fair, — Long forceps, with two blades of different lengths,
one when the face is to the right, the other when the face is to
the left, of the pelvis.
4!tli and Fairs. — Oblique forceps.
Note. — On the authority of Dr. J. H. Davis, it is worthy of
remark that the late Professor Davis was the inventor of the
shank.
Dayis's (Dr. D.). — "With five blades, two broad double-curved
with wide fenestrae — two narrow without fenestrae, also double-
curved, and one short straight blade. These, adapted in their use
to their special cases, actually form four pairs of forceps.
Datis's (Dr. D.). — Two pairs of (what Dr. Eadford calls)
twisted forceps for rectifying (as Dr. D. Davis says) the positions
of the foetal head. Each pair consists of two blades standing
obliquely to each other, one shorter than the other. They should
be covered with leather.
Dr. Gatton exhibited his Eoeceps, which are intended to
obviate the injurious effects of continued pressure on the foetal
head, by means of a tape firmly secured round the handles, when
it is within the grasp of the forceps. The inventor states, " My
addition simply consists of a means of junction on the old rack-
and-spring principle ; on the one handle the rack and spring is
placed, the other is flattened and tapered so as to be received into
the furrows made for it. When the blades are applied and the
instrument locked, it may be kept at any degree of compression
by simply raising the spring and allowing the end of the handle
to advance or recede as desired. In this way, duriug the interval
of pain, the pressure is in a moment taken off the foetal head, and
as quickly replaced ; nor do I believe does the addition in any
material way interfere with the action of the instrument, espe-
cially if the rack be kept downwards." 'Medical Times and
Gazette,' August 29th, 1863, pp. 217-18.
92
FOECEPS.
Dr. Giles's Foeceps are short and curved, with a hinge
adapted to the upper blade in such a manner that when they are
locked the tail of the blade, which is hinged, is shut into the
lock, and the blade cannot possibly shift until they are unlocked.
The lock is formed in the usual manner on the blade that is
hinged with a flange forming a groove ^ an inch deep. The
lower blade has no flange. The advantage in the hinge in the
upper blade is, that the handle is thrown forward, and the blade
can be introduced without altering the patient's position in the
bed, of course presuming she is lying in the ordinary obstetric
position.
Gtreenhal&h's (1) SnoET Stbaight, (2) Short Cukyed, and
(3) Long Cueved Foeceps. — The inventor states " that his in-
FiG. 70.
nuA-. No. 2. No. 3.
struments are strong, light, and wieldy, and suited to any and all
cases requiring the use of the forceps. The blades in the two
former are not so broad at their terminal extremities as in the
latter. The fenestra are sufficiently open at their lower extremi-
ties to admit of the protrusion of a small portion of the scalp and
FOECEPS.
93
even bone, as in Dr. D. Davis's forceps, so that there is little
or no addition made to the size of the head, and a firmer hold is
thereby obtained ; besides vrhich the soft parts of the child are
permitted to come in contact with the soft parts of the mother,
thus preventing all risk of bruising during extraction. The
blades are rounded out internally, and well adapted to grasp
firmly a spherical or ovoid body. The handles are short and of
roughened ivory, that shortness being compensated for by a ring
for the insertion of the finger or towel, by the aid of which any
amount of justifiable extractive force can be exerted, and the
shank, in the long forceps, which also enables the operator to
avoid undue distension and risk of laceration of the perinseura,
besides the inclusion of any of the soft parts within the lock.
In the long cxirved forceps the pelvic curve extends throughout
the whole instrument, as in Nsegele's forceps, by which a more
perfect adaptability to the curve of the pelvis, without stretching
the perinseum, is secured."
Haedojt's Foeceps. — The modification here consists in adapt-
ing a fixed pivot to the male and a narrow (button?) to the
female branches.
Mr. Philip Harper's Forceps are pecuUar in this respect,
that one blade has a fenestra so long that the opposite blade can
be passed through it, as will be seen by reference to the annexed
illustration (fig. 71).
Fig. 71.
HENNia's Forceps. — The inventor states that his instrument
is constructed on three principles, embodying —
1st. The pelvic curve of Joerg's forceps.
2ud. The shank of Dr. Hohl, to avoid too great stretching of
the perinajum.
3rd. The hooked handles, copied from the forceps of the Prague
School.
Hewitt's (G-railt) Forceps. — The inventor claims for his
94
POECEPS.
instrument greater facility of introduction and better adaptation
to the foetal head than can be secured by the ordinary forceps
in cases where, from severe labour, the occipito-mental diameter
is much elongated.
He states that his " instrument only differs from the common
straight forceps in use in this country in having longer blades,
and in the blades themselves having a different curve. The length
of the blades is 8 inches instead of 6^ or 7, and the curve is an
arc of a circle 14 inches in diameter, instead of 10 or 11 (fig. 72).
Fia. 72.
The instrument when locked is fitted to enclose a larger oval than
the ordinary forceps." (See ' Obstet. Trans.,' vol. iii, p. 190.)
HoFrM Ann's LoNa Poeceps, with shank and ring for finger
or handkerchief.
PoECEPS OE THE Peacute School (1820), modified by Professor
.Keassovskt, of St. Petersburg, exhibited by Professor Hugen-
BEEGEE, who states that this instrument has Busch's lock, and
was used by Professor Krassovsky as short or long forceps. He
also used them as a tractor before and after perforation of the
head, in cases of distorted pelvis, where the child was dead.
The Japanese Poeceps are chiefly remarkable for the shortness
(4|^ inch), narrowness of (f inch), and distance (1| inch) between
the blades, also for the straight fenestras.
The lock is peculiar, being formed by an aperture ^ of an inch
in length and the same in depth, slanting upwards in each limb
of the instrument at the junction of the blade with the handle.
They are made of steel, the blades being rounded off and
polished, the handles square, black, and dull, terminating in two
divergent flattened hooks (fig. 73).
FOKCEPS. 95
Fig, 73.
La-ZAE^witch's Poeceps. — The inventor claims for these the
following advantages :
1st. That, owing to the halves not crossing, it is immaterial
which blade is first introduced.
Fig. 74.
2ndly. Each half can be applied with equal facility, the first
one introduced not being in the way of the second. The inventor
considers this an especial advantage in cases where the head is
high in the pelvis and the vagina imperfectly dilated.
3rdly. The lock being in the handle, there is no fear of pinching
the soft parts or including hairs.
4thly. That when considerable contractive force is necessary
all hazardous pressure on the foetal head may be avoided.
Leyt's (Copenhagen) Foeceps, exhibited by Professor Nteop,
who describes this instrument " as a combination of the blades of
Naegele with the handles of Saxtorph, with small jointed wings to
support the fingers. The handles fold up upon the blades. These
forceps are in general use ia Denmark." (See fig. 75.)
Fig. 75.
9G
PORCEPS.
Fig. 76.
X
Mattei's Leniceps, ou Short Cueted Foeceps, are here
represented (fig. 76).
A Eepresents the left blade. B. The
shank, the corner extremity of which
(0) slides into the hole in the lower half
of the handle (d), where it is fixed by
a spring pivot running from E to D.
a'. The right blade fastened into the
upper half of the handle, at the inner
extremity of which are several steel notches
(1) for the reception of the opposite shank
(b), by which the distance between the
blades can be regulated, f g Shows the
upper and under halves of the rough
wooden handles joined, the application of
the instrument to the foetal head, and the
method of traction.
Mattel's leniceps come within the prin-
ciple of Assalini's and Lazare witch's for-
ceps— the blades not crossing, and therefore
not exercising compressive force.
"Where prolonged and forcible traction is required, M. Mattei
has constructed a square
framework of steel, a, b, o
(fig. 77), having on both
sides, at its upper extre-
mities, two excavations
for the reception of the
patient's thighs, to the
under surface of which the
apparatus is to be fii'mly
secured by straps (d, e)
crossing in. front of the
pubes, and passing over
the hips to the back,
where they are to be
fastened.
The leniceps being applied, M. Mattel attaches a rope (f) to
the transverse handle (g, h), while the other end is fixed to the
screw (k), by turning which forcible traction upon the forceps
can be effected over a considerable period.
Fig. 77.
FORCEPS.
97
Mattei's LoNa Cueted Foeceps, with movable articulation
and lock, 1855, are represented in fig. 78.
A, B, c, D, E, represents the instruments articulated, f, a, h,
I/, M, represents the articulation. The blade (b, d) is received
into the hole (l, m), and moves along it unless arrested by the
screw (g). The blade (a, e) is received into the groove (h), and
there fixed by the screw (f). At o the lock is seen fixed ; the
movable screws (p and g) admit of the lock being moved up or
down the blades.
Fig. 78.
A pair of Shout Forceps, inventor unknown, but used by the
late Dr. Samuel Merriman, were exhibited by his son Dr. S. W.
J. Mekriman, who remarks—" There is a straight piece of steel
with a cross-piece attached to the end, which, by means of a slide,
was placed uniform with the straight piece or made to stand
out like a T ; this was intended, I understand, to be used to
7
98
POECEPS.
bring through the pelvis the head after perforation, but was of
very little practical use." Dr. Merriman concludes — " These
forceps were the only kind used by my father, as he invariably
declined to use the long forceps, believing them to be injurious
or unsafe."
Mondotte's Fokceps are represented in this sketch (fig. 79).
The inventor thus describes them :
Fig. 79.
A. Is the pivot blade, b. The hinge blade, c, d. Two halves
of the handle, each carrying a blade, articulating with one another
FOECEPS.
99
by introducing the tenon into the mortice, fastened by the screw
(v) which enters the groove (v'). e. The screw which prevents
the movement of rotation of blade a. h. The screw which raises
the blade b, and enables the operator to seize the head without
compression, l. The screw which presses against the opposite
handle (o), and arrests the rotation of the two handles.
The screws not being used till after the introduction and ar-
ticulation of the forceps, all the dificulties of locking his instru-
ment disappear. The inventor also draws special attention to
the following points — the parallel handles ; the locks not cross-
ing ; the blades not compressing the head ; the distance between
the blades can be regulated by shifting the handles.
Dr. Eadfoed's Steaight Long Foboeps, with blades of un-
equal length — reversed position of the lock. The annexed sketch
(fig. 80) represents one of the blades just described, and is in-
tended to show the form of fenestrae, lock, &c. Fig. 81 shows
the blades locked.
Fia. 80.
The inventor says — The peculiarities of this instrument are
the long and short blade, the former to be placed over the face,
the latter on the occiput of the infant. It is sufficiently long to
be applied on the head when it is lying on or just entering the
brim of the pelvis. The shortness of the handles renders violent
compression of the infant's head quite impossible. Its construc-
tion is adapted more especially to that of a powerful tractor.
The oblong opening formed by the curve in the shank of each blade
is for the purpose of passing a silk handkerchief through, and
will enable the practitioner, in addition to his hold of the handles,
100
"FOECEPS.
to use very powerful and eftective extractive force. The reverse
position of the locks supersedes the necessity of all contrivances,
such as screw or hinge, between the handle and that blade whicli
(according to the usual construction) is placed on the upper side
of the pelvis, and is the one to be the last introduced. "Whereas
the position of the lock in this instrument requires that the upper
blade (assuming the woman lies on the left side) should be first
introduced.
Dr. Radford's Lon& Curved Porceps, with equal blades, are
here shown (fig. 82).
Fig. 82.
The inventor states that the object of the parallel shanks is
to prevent injurious stretching of the perineum and risk of lacera-
tion of the pelvic structures. Fig. 83 represents the two blades
of Dr. Eadford's long curved forceps just alluded to.
Fig. 83.
Dr. Radford's Long Double Curved Porceps consists of
three blades, two of equal length and double-curved, the other
shorter and straight. Pig. 84 represents the blades loclced and
in position,
^ Fig. 84.
rOECEPS.
101
Dr. Eadford remarks — The double-curved long forceps are
preferred by many practitioners, but this is not the case with the
inventor. His object was to meet the views of others. This
instrument is similarly consti'ucted to the straight, already de-
scribed, with the exception of the double-curved long blades, and
as consisting of three blades, one being shorter than the other
and straight. One of the long double-curved is to be placed over
the face and the short (straight) one over the occiput of the
infant. It will be quite obvious that two long double-curved
blades are required, not to be used together, but in order to apply
one or the other, according to the relative position of the face of
the infant, as the sTiorter straight is to be invariably placed on
the occiput. Fig. 85 represents the three blades just described.
Fig. 85.
The following Foeoeps were displayed by Dr. Eadfokd.
Long Forceps.
Conquest's, with perineal curves in shanks, and a screw in
one handle.
Davis's (D. D.).— With three blades— two long ones, flexible
at their extremities, having the pelvic curve. These blades ought
to be covered with leather and padded with flannel. They are
intended to lay over the face. There is also a shorter straight
blade to lay over behind the head.
102
EOECEPS.
Short Forceps.
Boee's double-curved, blunt hook at the handle — lock, an ob-
long projection on one blade received into a mortice on the other.
Denman's straight.
Haighton's. — PenestrJB slightly modified from his short
straight forceps.
Hamilton's double-curved, hinge in one blade.
Johnson's (R. W.) double-curved, not covered with leather.
Oeme's straight.
Smellie's straight, and covered with leather.
Professor Etzzoli exhibited three pairs of difierent sizes of
Long DoTJBLE-cuavED Fobceps.
1^^ Pair. — Blades very narrow and tapering at their extremities,
fenestra long and narrow ; handles flat, straight, lying upon and
parallel to each other ; terminating in a blunt hook, and hook
at right angles.
2nd Pair. — "With three blades broader, fenestrse wider ; handles
crossed like a pair of scissors, and broad, terminating in a blunt
hook, and hook at right angles.
3ri and smallest Pair. — Blades narrow and tapering ; handles
flat, and superposed like the first pair ; forceps key with a termi-
nal and central slit for turning the buttons of the locks.
Osboene's (supposed to be) double cuevbd, about half an
inch longer than Osborne's, which they closely resemble.
Pajot's Jointed Poeoeps resemble Charriere's, already re-
ferred to, but have at one extremity of the handle a blunt hook,
at the other a thread of silk, terminated by a leaden ball, for the
purpose of embryotomy, as recommended by the inventor. (See
Charriere's Catalogue, p. 120, fig. 308.)
Saxtoeph's Poeceps (1819), were exhibited by Professor
Fig. 86.
POECEPS.
103
Nyeop, who particularly draws attention to the small pelvic
curve and to the fact that they are still used by most of the old
practitioners in Denmark. They are represented in fig. 86.
Sir James Simpson's Shobt Forceps are here seen (fig. 87).
The handles are very short, and when locked the shanks of the
blades are so apart that the finger can be placed in the space
between them to facilitate the process of extraction.
Fig. 87.
Sir James Simpson's Long Fobceps are here shown (fig. 88).
The peculiarities are seen in the shape of the handles, and in the
hook at the top of each for the fingers to aid in extraction.
' Fig. 88.
M. Stille also exhibited a Forceps for holding and passing a
rope round a polypus when situated high up. It consisted of a
small steel rod, 16 inches with the handle in length, having a
small hook-like end. About 4 inches from this is a hinge by
which is fixed a rod with similar end. The two hooks, when
closed together, form a ring through which a rope can pass. The
second and shorter rod is kept closed by means of a spring press-
lug against the other side. "When it is required to release the
rope, pressure is made on the lower end of the second rod.
Unknown, steel handles and with blunt hook.
Unknown. — Double curve, one blade has a longer fenestra
than the other, through which the one with the shorter fenestra
is to be passed — when fully applied the two blades should lie
parallel, they are then locked.
One pair of double-curved forceps.
Unknown (T. Smith). — These forceps have the limbs of the
101
EOECEPS.
blades covered with leather, the fenestrae being open : they are re-
markable for the indentation in the upper extremity of each blade
which is rendered square by the leather covering, by the abrupt-
ness of the fcotal curve, by the shifting button-lock, and the diver-
gent handles terminating in converging sharp hook extremities.
They resemble Duse's forceps in the indentation at the upper
and terminal extremity of the blade, and Gifford's and Chap-
man's in the shape pf the handle.
Unknown. — One very short pair, wide fenestrae, scarcely any
shanks.
To sum up this report, then, we may remark that the chief
peculiarities of British forceps may be pointed out under the
following heads :
1. As to length. — The longest (Barnes), were 15 inches ; the
shortest (Collins), 10^ inches ; the average lengths varying in the
following order of frequency — 14, 11^, \2\, 13, 131 inches, the
first being the most frequent.
2. Length of Hade to lode. — The longest (Davis, D., and Ead-
ford), lOf inches; the shortest (Burton), 4^ inches; the average
lengths varying in the following order of frequency — 7, 8, 8^, 10|,
the first being the most frequent.
3. Length of Made to commencement of curve. — The longest
(G. Hewitt), 8 inches; the shortest (Burton), 4^; the average
lengths varying in the following order of frequency — 7, 6^,
7|, the first being the most frequent.
4. Lengtli offenestni/m.—Th.e longest (Chamberlen), Q\ inches ;
the shortest (Davis), 2f inches ; no fenestrum (Davis) ; the ave-
rage lengths varying in the following order of frequency— 4^, 5,
4, 41, 51 inches, the first being by far the most frequent.
5. Breadth of blade.— '^he broadest (Burton), 2J- inches ; the
narrowest (Davis), I of an inch; the average breadths varying in
the foUowing order of frequency— If , 2, li, 1§, the first being by
far the most frequent.
6. Divergence of apices.—The shortest (Smellie), -^th inch ; the
longest (Davis, D.),2i; no distance between (Burton) ; the ave-
rage divergence varying in the following order of frequency —|ths,
1, ^i-, itlia, the first being by far the most frequent.
7. Greatest divergence of blades.— The greatest (Chamberlen),
34 inches; the smallest (Burton and Smellio), 2 J inches; tlio
FOECEPS.
105
average distances varying in the following order of frequency — 3,
2^, 2f, the first by far the most frequent.
8. Pelvic curve in forceps. — The shortest (Hamilton), |th inch ;
the longest (Eadford and Greenhalgh), 3 inches ; the average
amount varying in the following order of frequency — 2, 2|-, 2^, 3,
2f , the first four being equal.
9. Form of loch. — Ordinary (Smellie's), 14 ; ordinary, with
shanks, 11 ; ordinary, shanks with ring, 5 ; ordinary, with
ring, 4 ; ordinary, one-sided, 2 ; hall for tape, 2 ; Ziegler's, 2 ;
ordinary with curved perineal shanks, 1 ; rack and pinion, 1.
10. Structure and forms of handles. — Wood, 34 ; ivory, 5 ; iron,
3 ; smooth, 28 ; rough, 8 ; short, 5 ; long, 36 ; straight, 38 ; curved,
1 ; bow, 2 ; finger-rests, 5 ; hedged, 2 ; screw, 1 ; spring rack at
extremity, 1 ; shifting handles, 1.
The chief peculiarities of Foreign forceps may be pointed out
under the following heads :
1. As to length. — The longest (Van Huevel), were 20^ inches;
the shortest (Mattei and Mondotte), 11 inches; the average
lengths varying in the following order of frequency — 16, 18, and
13, the two former being more frequent and equal.
2. Length of Made to loch. — The longest (Baudelocque), 10^
inches; the shortest (Mattei and Duse), 7 inches; the average
lengths varying in the following order of frequency — 8|^, 9^,
10, 9-L, 9, the first being most frequent.
3. Length of blade to commencement of curve. — The longest
(Van Huevel), 10 inches ; the shortest (Hugenberger), 5^ inches ;
the average lengths varying in the following order of frequency —
6, 6^, 7, 7^, the three former being equal and far more frequent
than the latter.
4. Length offenestrmi. — The longest (Baudelocque and Mattei),
6 inches ; the shortest (Siebold), 2f inches ; no fenestrum (As-
salini and Duse) ; the average lengths varying in the following
order of frequency — 5^, 5, 4|, the first being the most frequent.
5. Breadth of blades. — The broadest (Campbell and Mattei),
2^ inches ; the narrowest (Assalini, Chassagny, Duse, Levy,
Saxtorph), 12 inches ; the average breadth varying in the follow-
ing order of frequency — 1|, 2, 2^, 1-^, the first being far more
frequent.
(5. Divergence of apices. — The shortest (Faye, Levy, Lovati,
106
FORCEPS.
Naegele), ith of an inch ; the longest (Pajot), If inches ; no dis-
tance (Chassagny). The average divergence varying in the fol-
io vising order of frequency— ^, the first being most frequent,
the two next equal.
7. Greatest divergence of blades, ^he greatest (Duse), 3|
inches; the smallest (Faye, Eizzoli Losati), 2^ inches; the
average distances varying in the foil .ing order of frequency —
2i> 3, 2^ 2i, 3i, the two fii st being far more frequent, the three
following equal.
8. Pelvic curve.— Vhe shortest (Saxtorph), 1^ inch ; the longest
(Assalini), 5f inches ; the average amount varying in the follow-
ing order of frequency— 2a, 3^, 2i, 2f , If, 3§, the first most fre-
quent, the last four being equal.
9. Form of loch. — Button-screw, 11 ; pivot, 8 ; ordinary
(Smellie), 4 ; ordinary, one-sided, 4 ; hall in handle, 2 ; tenon and
mortise, 2 ; shifting, 1 ; sliding, 1.
10. Structure and forms of handles.— Iron, 15 ; wood, 14 ;
rough, 7 ; smooth, 6 ; long, 31 ; parallel, 29 ; horizontal, 2 ; finger-
rests, 6 ; fluted, 2 ; bow, 2 ; blunt hook extremities, 9 ; perforator
at extremities, 1 ; rectangular extremities, 1 ; shifting handles, 1 ;
folding handles, 1.
It now only remains to point out the chief peculiarities between
British and Foreign forceps :
The British are shorter, lighter, and less powerful than the
Foreign instruments ; the former terminating usually in straight
wooden, the latter in blunt-hook steel handles. Owing to the
comparative shortness of the blades of the British forceps, the
cranial curve is somewhat more abrupt than in the Foreign instru-
ments, in which, when locked, the blades, both at their apices and
greatest divergence, approximate more closely, by which far
greater compression can be exerted on the foetal head. There is a
very slight difference between the breadth of the blades and fe-
nestrse, which, however, are longer in the foreign instruments.
The straight forceps rarely used in continental practice are not
infrequently had recourse to by British practitioners, especially
among the Irish. In the double curved forceps the pelvic curve
is greater in the Foreign than in the British instruments.
There is also considerable difference in the form of locks, the
ordinary double lock of Smellie greatly preponderating among
British, whereas the button-screw and pivot are far more frequent
FOECEPS.
107
among continental practitioners. Thus it will be seen that the
Foreign is a far more formidable instrument for compression and
extraction than the British forceps.
Aa types of British fo: '^s, the instruments of Chamberlen
and Smellie ; of Foreign, J -.^se of Levret, may be considered as
good examples.
no
II. Foot Foeceps.
The following Foot Foeceps may be noticed :
1. Dr. GtEoniting's, invented in 1815, exhibited by C. Nybop,
Copenhagen.
2. Dr. DisTEiCTSLffiaE, E. Nxeop's, invented in 1853, ex-
hibited by C. Nyeop, Copenhagen, and is represented in this
sketch (fig. 89).
Fig. 89.
3. Prof. Lazaeewitch's, of Charkoff, Russia, exhibited by
himself.
Prof EizzoLi exhibited two varieties of Foot-Foeceps, of
which the accompanying sketches are illustrations (figs. 90 and 91).
Fia. 90.
108 POECEPS.
FiQ. 91.
One of them works like a pair of ordinary scissors, tlie extremities
of each blade forming the segment of a circle and being placed
at a somewhat acute angle with the shaft. The other, as is seen,
opens and shuts by an action of the handle which is communicated
along the shaft of the instrument.
III. MiSCELLAlfEOUS.
CANtJL^i3 VuLSELLUM FoECEPS, Containing two, three, or more
arms as hooks, were exhibited by Dr. Gtbeenhalgh and Messrs.
"Weiss and Peegusojst.
Mr. CoxETER also showed various Forceps eob, Uterine Ope-
BATiONS, one of which is represented in this illustration (fig. 92).
Fi&. 92.
Mr. Ferguson exhibited a pair of Canula Forceps or Vul-
sella, of which the annexed drawing gives an illustration (fig.
Fig. 93.
93). The canula slides up and down the handle, closing the
blades and guarding the soft parts from injury in the passage of
the instrument up to the body to be seized.
FOECEPS.
109
Fehgtjson also exhibited a pair of Museattx's Vxtlsellum
FoBCEPS, with two or three hooks, as represented in this sketch
(fig. 94). The blades are fastened together in the ordinary way.
Fig. 94.
110
FORCEPS.
A pair of Guaudeb Vulselltjm Fouceps, made by Mr.
PEKausoN at the suggestion of Dr. Charles West, of which a
representation is given below (fig. 95). The guard is of silver,
and they were exhibited by the maker.
Fig. 95.
The same maker showed the Jointed VrLSELLUM Fobceps of
Sir James Simpson, the blades having two or more hooks. The
lock was the same as that used in ordinary midwifery forceps.
A pair of Long Uterine Fokceps, with rack in the handles
to fix the blades, were exhibited by Lijee.
Messrs. Mayee and Meltzee exhibited a somewhat similar
instrument, made by Charrifere originally, at the suggestion of
Dr. Marion Sims : it is represented in this sketch (fig. 96), and
is called by Dr. Sims Polypus Foeceps.
Fig. 96.
The same maker also showed Dr. Bennet's Double Tena-
culum Foeceps, for seizing the cervix uteri in cases of amputa-
tion. The accompanying sketch is an illustration of it (fig. 97).
I
FOECEPS. Ill
A pair of Uteeine Speculum Poeceps, with treble joint, were
exhibited as invented by Matthieu, and are represented below
(fig. 98).
M. Matthieu also showed a pair of Polypus Poeceps,
furnished with a slide for the purpose of keeping the blades
firmly closed, so as to avoid the tiring compression of the fingers.
Messrs. Maw and Son exhibited a pair of useful Speculum
PoECEPS, which are represented in this sketch (fig. 99). The angle
Pig. 99.
at which the handles are set enables them to be used without in
any way interfering with the line of vision along the speculum.
Dr. McClintock's Penesteated Poeceps, for seizing uterine
112
FOECEPS.
polypi, is represented in the preceding sketch (fig, 100). Speci-
mens were exhibited by Mayer and Meltzee, by Weiss, Maw,
and other makers.
M. Mette, of Stockholm, exhibited a Poue-hladed Vul-
SELLTTM for fixing the os or cervix uteri. The hooks were con-
tinuous with the body of the instrument, and were controllable
by a movable spring.
A Pair of Pobceps for applying or removing lint in operations
on the uterus were exhibited by M. Stille, of Stockholm. They
were invented by Dr. Nitzel. Tlie handles were straight and
trowelled,
A pair of SPEOiJLirM Foeceps were exhibited by Feegtjson,
and are represented in the annexed drawing (fig. 101.)
Fig. 101.
The PiNCE-^EiQNB, of EoBEET, was exhibited by Dr. Peiestlet.
This instrument is represented in the annexed sketch. At its
Fig. 102,
terminal extremity are three stout teeth fixed on a movable joiut
(a a), the whole being enclosed in a guard or sheath (a'). At
c c are two clips, which fix the guard, as represented at a', and
FOETUS EXTEACTOES.
113
on removing the clips and turning the screw at B b', the stem of
the guard is drawn down, and in so doing the teeth or pincers
are projected at the same time that they are uncovered, until
they are set at right angles to the shaft, and in this movement
they are simultaneously inserted into the mass they are intended
to grasp. The two blades of the forceps unlock readily at the
joint, and are intended to be passed up the uterus or vagina
guarded, until, being placed one on each side of the tumour, they
are again locked and the teeth projected.
Mr. Pkatt exhibited, among other varieties of Pobceps, that
represented in the subjoined sketch (fig. 103), which were made
for Mr. Baker Brown's operation of clitorodectomy.
Fig. 103.
Messrs. Weiss showed a pair of Specitltjm Forceps with
trowelled shanks ; handles and blades crossed.
Messrs. Weiss also showed a pair of Uteeine Polypus
FoECEPS, with cross-acting blades, and rack movements for fixing
the blades in any position.
A pair of Sliding Vulsellfm Fobceps was exhibited by
Messrs. Weiss. The instrument consisted of two blades which
could be introduced separately and were fixed by a shifting joint,
so that each blade could be brought to act at unequal depths in
the uterus or vagina, traction being possible in an oblique or any
other direction. The blades were secured in any position by
means of a sliding bolt.
FORCEPS SCIE (vide Decapitators).
FCETUS EXTRACTORS.
A case shown by Lueb, of Paris, containing —
1. A trepan for perforating.
8
114
FCETUS MEASUEEE.
2. A sucker to draw out the brains of the foetus after per-
fo ration.
3. A sucker combined with a tire-tete, by which finally to
draw down the bead.
SiE James Simpson's Suckee composed of a cup of vulcanised
mdia rubber, to tbe centre of which an exhausting gauge is
attached. The inside of the elastic cup is soaped and carefully
fitted on the scalp ; the air is then exhausted and the instrument
holds on firmly : traction is then employed.
FCETUS MEASURER.
Professor Nyeop, of Copenhagen, exhibited an appaeatus for
MEASUEiNa THE Newlt Boen, which is depicted in this illustrar
tion (fig. 104) ; B is the foot-board, and c the movable head-board,
which works on pretty much the same plan as the ordinary rule
used by shoemakers for measuring the length of the foot. A
graduated rule is attached at the side, and an indicator on the
head-board, c, marks the total length on the indicator. In like
manner the taking of the length between the umbilicus and
either extremity, and the dimensions of other parts, are provided
for in this apparatus, which was made of polished mahogany and
steel mountings.
Fra. 104.
FUNIS REPLACERS.
115
FUNIS REPLACERS.
We may notice those of Dr. D. D. Datis, exhibited by his
son, Dr. Hall Dayis, of which there were two kinds. Both
were composed of flat pieces of metal, straight, about 12 inches
long and f of an inch wide. One was uncovered, having small
holes at one end for the string to pass through. The other was
covered with leather without holes.
A slight modification of these was shown by Dr. Hall Davis,
in which the small holes at the top were replaced by two larger,
an inch below.
Sir Chas. Locock's instrument was composed of two whale-
bone rods — one straight throughout, the other curved for about
an inch at the top. The straight one was movable, running
through an eye attached to the other at the lower part of the
curve ; so that the funis, when included in the space within the
curve, can be released readily by drawing down the straight rod
and opening the ring thus formed.
Dr. Roberton's was exhibited by the inventor. It is a very
simple instrument, composed of 12 inches of half-inch india-
rubber tubing closed at one end. A stiffener (stillet, or uterine
sound) is passed up within it to the top ; when used, a tape is
loosely fastened round the funis, and then the tape is tied round
the end of the tube. After the funis is replaced, the stillet is
withdrawn, the rest remaining behind, and being of a very soft
nature, no injury can be inflicted on the uterus.
HYSTEROTOMES (see Metrotomes).
116
KINOMETER— LEECHES.
KINOMETER.
The Kinometeh, invented and exhibited by Dr. Rotjth, was
devised by him to measure the amount of uterine movement, as an
aid to the diagnosis of certain morbid conditions in that organ.
It consists of a speculum, closed at the vaginal end by a caout-
chouc membrane ; the distal end terminates in a glass tube bent
at a right angle, in a part of which there is a tap. The whole is
filled with coloured water ; the vaginal end being pressed on, the
water rises in the tube. When the instrument is introduced, the
tap is opened, and then two movements are noticeable — one syn-
chronous with the pulse, the other with respiration. It has been
found, in uterine haematocele and cellulitis, the respiratory move-
ment is almost entirely absent, and that in fibrous tumours both
are generally obvious.
LEECHES, &c.
Various Appliances eob the Application op Leeches to the
Ceeyix ob Vagina were exhibited. Of these the most ingenious
was the instrument called by its inventor, M. Stille, of Stock-
holm, an Abtieicial Leech. It contained a small cutting
instrument very similar to the ordinary leech-piercers ; this was
enclosed in a kind of section tube, which could be easily filled
with blood after the punctures had been made ; in fact, it
resembled in principle the cupping-glass scarificator of Luer.
Mr. Ebrgtjson exhibited his Leech Cages, one of which was
composed of wire gauze, into which the leeches were to be caged.
"When applied to the cervix, the cage can be opened by pulling
a ring at the end of the handle, and thus the leeches are enabled
to lay hold of the surface to which they are opposed.
LENICEPS (see Forceps, Midwifery).
LEVER (see Vectis).
MEMBRANES, Instruments for Puncturing (see
Premature Labour).
METEOSCOPES.
117
METROSCOPES (see also Specula).
Professor Keassovskt's was exhibited by Professor Hugen-
BEEGEB. The handle of the instrument is like that of a pair
of scissors, and at its extremity is a trivalve speculum. The
blades open by closing the handles, which are kept together by
means of a screw.
The blades are 1^ inch long, and when closed measure at their
point the ^th of an inch ; when opened, \ of an inch. The plug
and speculum resemble in miniature Madame Boivin's speculum.
The whole instrument is 9^ inches long, and is used through any
ordinary cylinder speculum. It is represented in the annexed
sketch (fig. 105).
Fig. 105.
The Meteoscope of Dr. G-eunevaldt was exhibited by Pro-
fessor Htjgenbeegee. — This instrument is a modification of
Desormeaux's endoscope, and consists of two metal tubes (twisted
inside), coniform in shape (fig. 106). Of these two tubes the shorter
passes through the longer one, which, at a distance of 2 to 2|- inches
Fig. 106.
from its point, obliquely cut, has a joint movable to an angle of
118
METEOTOMES.
130° ; to this tube belongs a whalebone shaft or guide, terminating
in a button point. The tube's angle is retained by this whalebone
when the instrument is being introduced into the cervical canal.
After its introduction, by turning the guide to the right, making
it revolve on its own. axis, it is gradually withdrawn, and the smaller
straight tube is then introduced. The angle of the larger tube
being movable is straightened by the introduction of the straight
smaller tube, and a full view of the uterine cavity is then ob-
tained.
Dr. Ttleb Smith's Meteoscope, made by Messrs. Weiss. —
This instrument is applied through the speculum described further
on (vide Specula). It consists of two parts — a mirror and a
cylindrical tube, both provided with long handles. By means
of a screw the mirror can be inclined to any angle, so as to
receive and transmit a ray of light through the tube. The tube
(which is of three sizes), after having been gradually introduced
into the os uteri, is retained in situ by means of the pliant
wire which fixes the handle. The mirror is fastened to the lower
blade of the speculum at two points.
METROTOMES.
Oe instruments for dividing the cervix uteri there were a great
variety, the difference in their construction having reference
chiefly to the desirability of having one or two blades ; some
authors recommending one, others two, the latter being careful to
obtain simultaneous and equal division of the two sides of the
cervix.
Sib James Simpson's Instetjment is a kind of bistouri
cache; the end of the instrument which carries the knife is
about 2\ inches long, and the size of an ordinary uterine sound.
The blade is kept closed by the force of a spring acting upon
the handle, and is forced out by pressure approximating the
two handles, the degree to which the blade is projected being
regulated by a screw fixed into one of the handles. By this
instrument one side only is cut first, the instrument is then
reversed and the other side is similarly treated, the cutting being
effected partly by the projection of the blade and partly by the
METROTOMES.
119
withdrawing of the instrument while the blade is thus exposed.
The instrument is represented in the adjoining sketch (fig. 107).
Fig. 107.
Dr. Coglak's Metkotome consists of a central blunt or probe
point less than a ^ of an inch long, about the thickness of a
No. 1 bougie, and proceeding from this are two cutting sides
about gths of an inch wide. The whole instrument, including the
handle, is about 8^ inches long, and is slightly curved for 3
inches from the point to correspond with the oblique position of
the uterus. The advantage contended for by the author is that
with this instrument, guided by the probe point, we are sure with
ordinary care to have our incision right into the uterine cavity,
and perfectly central, and by using instruments of different
widths we can have our incision of the exact extent it is required.
Eor the purpose of keeping the incised part open the author
employs a piece of sheet lead rolled out so thin as to be very
light and flexible, but sufBciently thick to retain its shape, about
1 inch long and f of an inch wide ; this is rolled up into the form
of a tube, the edges of the ends being slightly turned out into a
lip.
Dr. Gueenhalgh's Bilateeal Metrotome. — This instrument
is llA inches in length, and ends in a blunt extremity like a
uterine sound, 2^ inches long. It consists of two lateral halves,
which can be fii'mly clasped together ; each half contains an in-
clined plane, regulated by an adjusting screw, upon which a blade
is made to move downwards and outwards by pulling the handle
of the instrument.
The advantages claimed by the inventor for this instrument
are — 1. Its extreme simplicity ; it can easily be cleaned. 2. Its
use requiring no exposure of the patient. 3. Its easy, safe, and
painless application. 4. Its cutting from within outwards,
the blades gradually diverging, thus dividing the internal os
slightly, the external os freely. 5. The accuracy with which the
120 METEOTOMES.
direction and extent of the incisions can be regulated. 6. The
rapidity and certainty of its action.
The instrument is represented in the annexed sketch (fig. 108).
Eig. 109 shows the instrument in action, or rather the sup-
posed line of incision, as seen in the dotted lines.
Fio. 108.
METROTOMES.
121
In Dr. Satage's DouBiiE-ACTioir Meteotome the divergence of
the blades is produced by the action on two pins in the contrary
direction of the semi-elliptic curved shanks, the extent of incision
being graduated by moving the pins. The instrument can be
used ^vith one hand. The amount of divergence of the blades
consequent on drawing down the shanks (by the single handle)
within the sheath depends on the shape of the ellipse ; the blades
fall into the sheath immediately on completing the incision.
Dr. Baekes's Instetjment (fig. 110) foe dittding the Ceevix
TJteei consists of a modified pair of scissors. One blade, strong
and somewhat probe-shaped, passes through the narrow os into the
cervix, whilst the other blade, slightly concave on the cutting
edge, so as better to seize the rounded surface of the cervix, is
applied at any point of the vaginal portion the operator chooses.
Fig. 110.
122
METROTOMES.
The author claims the following advantages for this instru-
ment : — 1. That hy it we are sure of cutting exactly as much as we
want, and no more. 2. That in cutting from wdthout inwards
instead of from within outwards we are cutting towards safety and
not towards danger. 3. That it cannot cut deep into the sub-
stance of the cervix in a level with the os internum. 4. That the
incision partakes of the crushing character. 5. That the instru-
ment is most simple, inexpensive, and not likely to get out of
order. 6. That the wound made by it is not less likely to re-
unite by first intention, as it gapes better than that made by
knives.
The instrument is represented in action in the above sketch
(fig. 110), and the scissors are here shown (fig. 111).
Fig. 111.
Mr. Spencee "Wells' instrument contains two blades, each
about 2 inches long, lying one over the other, and when
united are about the size of the common uterine sound. The
back of one blade protects the edge of the other ; they are united
together at their extremity by a joint. By pushing a sort of
trigger the blades open in such a way that the one moves up-
wards, the other downwards. The size of the incision can be
precisely regulated by a movable guard. No speculum is re-
quired. The cervix is divided equally on both sides, instan-
taneously, safely, and without exposure to the patient.
METEOTOMES.
123
Fig. 112.
0
Dr. Avelikg's instrument was
invented in 1865. It is like Sir J.
T. Simpson's, except that the hinge
of the blade is at the point instead
of at the centre of the instrument.
By pressing the handle an incision
is made, slight at the apex and
broad at the base. The inventor
formerly used a double hystero-
tome, but discarded it, because the
thinner and more yielding side of
the uterus was divided by it to a
greater extent than that which was
thicker and firmer, and which con-
sequently required division most.
The instrument is represented in
the accompanying sketch, half size
(fig. 112).
m
v..
After the operation of hysterotomy, as well as at other times,
the author uses an intra-uterine spring tent which he originally
invented in 1864, to obviate tlio inconvenience which was caused
124
METEOTOMES.
by the ordinary stem slipping out. Some have experienced diffi-
culty in withdrawing this instrument ; this, however, may be easily
overcome by tying a piece of thin string to the base of the inner
slide. By this it may be withdrawn into the tube, and the in-
strument will then come out readily. These instruments are also
represented below, half size (fig. 113).
Fia. 113.
In fig. A the dotted lines represent the springs withdrawn into
the tube and ready for introduction. Fig. b is a stalk, the end
of which fits into a, and is used for the purpose of introducing
the latter into tlie uterine cavity. There is a regulating screw
represented at c in the drawing of the hysterotome, upon which
the handle of the instrument is pressed in cutting, as is seen in
the sketch.
Dr. Marion Stms' Methgtoime comprises two blades, which
are, when not in use, retained in the body of the instrument;
METEOTOMES.
125
beyond this projects a very fine probe-pointed guide, which is
smaller than the common sound, and along this, by pressing one
or both of the rings at the other end of the instrument, the blades
slide. The instrument is so constructed that the blades may
either be used singly or both together.
These points are very well represented in the accompanying
sketch, where it will be seen that the blade of one side is pro-
jected, while that of the other is only shown in dotted lines
(fig. 114).
Fig. 114.
Dr. Sims also exhibited the following instruments, which are
employed by him in the operation for the division of the cervix
uteri.
First. The small tenaculum figured in the annexed sketch
Fig. 115.
(fig. 115), which is used for pulling forwards and fixing the cervix
uteri.
Secondly. The steaight-bladed but angular, ob the cueved
scissoBS represented below (fig. 116), by means of which the
Fig. 116.
cervix is divided, one blade of the scissors passing into the cer-
vical canal.
Thirdly. The part of the cervix between the cut portion and
the internal oa or cavity of the uterus is divided by means of the
12G
METEOTOMES.
SMALL BLUNT-POINTED KNIFE represented in the annexed sketch
Fig. 117.
(fig. 117) ; this is fixed in a handle and maybe set to any angle by
a screw at the end of the instrument, as is seen in this sketch
Fig. 118.
(fig. 118). If any haemorrhage occurs, it is to be controlled by the
application of a small bit of sponge in a probang saturated with
some styptic solution.
The adjoining sketch represents the tntea-xjteeine expand-
ing STEM which is inserted into the cervix after division of that
canal (fig. 119).
Fig. 119.
Mr. Philip Habpee's Metrotome is represented in this
sketch (fig. 120). This instrument is intended for use in cases of
Fig. 120.
labour where from any cause the cs is rigid, hard, and undi-
METEOTOMES.
127
latable. It may be applied as a scarificator when the os is in-
flamed, or to divide more deeply in cases of absolute partial or
complete rigidity, and where rupture of the uterus is dreaded.
The body of the instrument /is flattened upon its sides, and of
suflBcient strength to be easily manipulated when the end d is
introduced through the os. Along the upper part is a sliding
rod, c, d, curved at right angles, and capable of being fixed in any
desired position by the screw e. This rod is grooved along the
under surface to allow the blade ah to ghde easily in it. "When
in use the sliding blade is fixed to a length corresponding with
the thickness of the os which is to be cut, and the blade a b
being drawn back into its sheath, the instrument is passed through
the OS which is thus grasped between the curved point d and the
end of the body. The blade is then pushed out by pressing upon
the handle a, and thus cuts through the part of the os against
which it is placed. If it be desired to make a deep incision, the in-
strument can then be used as an ordinary knife. If we wish to
divide the os in another part, the blade is withdrawn into its
sheath, the instrument turned round and the blade again pressed
out and so on.
"We have thus the power of making any number of incisions
we desire, either shallow or deep, and with perfect incapability
of injuring the child or doing more than we wish to the mother.
Professor Fate, of Christiana, exhibited three knives which he
uses for this operation. Two of them are flexed at different
angles ; the other one is straight. They are slender, narrow
blades, about l-l inches long and about ^th of an inch wide,
fixed in handles of about 6 or 8 inches in length.
Professor Lazaeewitch exhibited a knife which he thus
describes : — For the incision of the vaginal portion of the womb
I employ a knife similar to a tenotome, the handle of which is
5 inches in length, and in which are two blades each 3^ inches
long ; for about an inch at the end of the blade there is a common
sharp edge, the opposite side being concave and blunt ; the point
of one blade is sharp, that of the other blunt and thick ; and he
adds, I perform the incisions not on the external surface of the
neck of the womb, but introduce the point of the knife into the
orifice and cut the anterior and posterior lips. From two to four
such incisions may be made— the depth being 1 line, and the
length from 3 to 4 lines.
128
METEOTOMES.
The following are given by the author as the special advan-
tages of this operation : — 1. That the incisions are made in all
directions with facility. 2. That more blood is discharged than
by incision on the external surface of the lips. 3. The wounds
are not irritated by contact with the vaginal walls from which they
are protected by the uncut outer portion of the cervix.
Mr. Smith, of Christiana, exhibited through M. Mettk, the
instrument maker, a somewhat complicated but ingenious double-
BLADED HTSTEEOTOME. It was SO Constructed that the back of
one blade became the guard of the cutting edge of the other.
When introduced within the cervical canal, the two blades were
separated with their cutting edges towards the cervix and exactly
parallel to one another, so that the incisions were effected on
both sides at once, and parallel, thus cutting as deeply above as
below. Moreover, as the divergence was slowly accomplished by
a screw process, the incisions were also slowly made. The in-
strument is represented in this sketch (fig. 121).
Fig. 121.
Dr. EouTH exhibited a curious old long-bladed Htstee-
OTOME, manufactured by Maddox, University Street. The me- •
chanism is also the same as that of Sir J. Simpson's instrument,
only it is double-bladed and not so wide in the middle portion.
It is also bent superiorly at the end like the curve of Simpson's
sound. It may be used in the same cases where Simpson's is
inadmissible, and in cases of fibroids where the uterine cavity is
much prolonged, or where the fibroid is in the upper portion,
and where it is wished to injure the growth so as to promote its
absorption.
Dr. EoTJTH also showed his dotible shobt-blaked Htstek-
OTOME, manufactured by Coxetek, which is represented in the
subjoined illustration (fig. 122). The blades are protruded by
Fig. 122.
METROTOMES.
129
drawing down the handle as is here re-
presented, and so far it and Dr. Green-
halgh's instrument resemble one another,
but it appears to be somewhat simpler
in construction, and can easily be taken
to pieces. The line of incision made by
both instruments is about the same.
Fig. 123.
Dr. EorTH's Metrotome, exhibited
by Messrs. Maw and Son, and here
represented (fig. 123), acts upon the
principle of Sir James Simpson's instru-
ment, but with this difference, that it is
double-bladed, the two blades being pro-
jected simultaneously by pressing on the
spring at the handle. The blades diverge
at their extremities, and are united at
their proximal ends.
M. Stille, of Stockholm, sent a Me-
TBOTOME, of which the accompanying
sketch is an illustration (fig. 124). The
cutting is performed by the two little blades which, by pressing
on the handle at the end of the instrument, are projected at right
Fio. 124.
130
MISCELLANEOUS.
angles to the shaft, as is seen in the drawing. The handle referred
to works up and down within the prescribed limits by a spring.
Fig. 125.
1
MISCELLANEOUS.
The annexed sketcli (fig. 125) repre-
sents Dr. Maeion Sims' Uteeoe Ele-
vator, with the uterine stem, a, set at
an angle of 45°, being the proper angle
for an ordinary retroversion, o is the
ball or disk for the support of the weight
of the uterus. It revolves on its own
axis in a line with the shaft, permitting
the stem a to describe a whole circle
except 90° — 45° on each side of the shaft.
This ball is perforated with seven holes
(the stem occupying the eighth) made in
a line around its centre, for the reception
of a pointed rod, concealed in the tubular
shaft, which is pulled down by the ring
B, and flies back again when we let the
ring go, so that the movements of the
uterine stem a can be promptly arrested
at any desired point in its elevation,
simply by letting go the ring b, which,
with the rod, is driven up by a hidden
spiral spring in the handle below. The
little perforations in the ball are placed
intentionally at the proper distances to
mark off angles of 45° in the revolutions
of the stem.
MISCELLANEOUS.
131
Dr. Maeion Sims' Uteeinb Depeessoe is an instrument used
for bringing the os tineas into view in vaginal examinations, by
djawing the neck forwards by pressure in the anterior cul-de-sac.
It is represented in the subjoined illustration (fig. 126.)
Fig. 126.
The accompanying drawings represent Dr. Maeion Sims'
Sponge Tents, which are made by Messrs. Mayer and Meltzer.
They are here seen of the natural size, and by a peculiarity
FxG. 127.
in their manufacture, they are much smaller in the dry state
than those ordinarily in use, though, at the same time, their
dilating power is quite as great. They are therefore easier
of application, and more efficacious than those commonly em-
ployed.
The annexed drawing represents Dr. Maeion Sims' Sponge
Peobang, used for wiping bleeding surfaces in vaginal operations.
It is made by Mayer and Meltzer.
Fig. 128.
132
MISCELLANEOUS.
Fig. 129.
Dr. Sims' Pobte Tampon is here re-
presented. It is an instrument designed
for the purpose of enabling the patient
to apply a cotton pessary to herself.
The requisite quantity of cotton, tied in
the middle with a strong thread, some
eight or ten inches long, is placed in the
porte tampon ; the lid is then shut ; the
instrument is introduced like an ordinary
speculum, the patient on the back ; it is
to be pushed firmly and forcibly back-
wards and downwards under the cervix
to the posterior cul-de-sac. Then the
piston is to be pushed forwards, the
tampon is left in its place, and the in-
strument is withdrawn. The string pre-
viously attached to the cotton hangs from
the vagina, and with this the tampon is
removed when necessary.
Eig. 130 is another form of the same
instrument.
Tig. 130.
MISCELLANEOUS.
133
Fig. 131.
Fig. 131 represents Dr. MAEioiir Sims'
Uteeine Guillotine. It consists simply
of a blade added to the ecraseur. In
applying the instrument, let the loop f
encircle the cervix where we wish to cut
it off, turn the screw nut, h, till the loop
embraces the part firmly and immovably,
transfix the cervix with the needle by
means of the slide d, then push the blade,
e, quickly forwards, by forcing down the
sliaft, a, and the part will be instantly
cut through. The dotted lines I, i,j show
the relations of the loop, needle, and
knife when the operation is finished.
a,
13-1
MISCELLANEOUS.
Fig. 132.
The annexed sketch represents Dr.
Mabion Sims' Gtlass Sybinge used
for injecting the cavity of the uterus.
It is so constructed that the exact
quantity of fluid to be injected can be
regulated. There is a little screw nut,
a, which can be turned against the
piston rod, upon which a screw is cut.
This prevents the piston from being
forced down except by the action of
the screw. Half a revolution of the
piston will force out half a drop, a
whole revolution a whole drop, and so
on.
MISCELLANEOUS.
135
Messrs. Weiss & Son exhibited a Portable Case oe Insteu-
MENTS for minor operations on the uterus and vagina, of which
the accompanying sketch is an illustration.
Fig. 133.
It contains three silver-ended sounds of various sizes ; caustic,
blue-stone, and lint holders ; three knives ; Marion Sims' angular
hook, double-pointed hook, tv?isted double hook, and stem for
introducing spring uterine tents.
Instruments for the "Bead" Sutttee. Designed by Mr.
Charles Brooke, and constructed in 1840-1, were exhibited by
the inventor ; they comprised —
1. Lateral -longitudinal forceps.
136
MISCELLANEOUS.
2. Lateral-transverse forceps.
3. Universal scalpel, the blade of which can be placed in any
direction.
4. Eight and left-handed transverse spiral needles.
5. Do. do., oblique spiral needles.
6. Movable needle, for transverse vaginal fissure, or cleft
palate.
7. Port-ligature. The point of the needle is brought out
through the ring, and the ligature lodged in the notch of the
needle.
8. Instrument for running down the knot to the bead, and
then tightening it.
9. Hook for placing the second bead on the double ligature.
Mr. CooPEE exhibited the Beitish Feeding Bottle, the
principal merits of which are that it is very easily cleaned. The
supply of food is regulated by an electro-plated stopcock ; the
admission of air into the stomach is prevented ; the teat is very
soft enamelled india-rubber, finely perforated, to imitate the
nipple, which can be instantaneously removed, washed, and wiped
dry.
An Ikvalid's G-lass for administering fluids while the patient
is in a recumbent position.
loDoroEM, recently introduced as a sedative.
OBSTETEIC BAGS AND CASES.
137
OBSTETRIC BAGS AND CASES.
These contrivances have been designed chiefly for portability,
and with the view to contain in the smallest space the appKances
usually required in cases of emergency.
Babnes' Midwifeet Ba&, conveniently arranged with pockets
and compartments, contains — Barnes' midwifery forceps, per-
forator, craniotomy forceps ; instrument for perforating mem-
branes ; Simpson's sound for introducing uterine dilators ; folding
lever ; blunt hook and crotchet ; straight scissors ; umbilical
cord scissors ; probe-pointed straight bistoury for incising cervix
uteri ; set of Barnes' uterine dilators, with mounts and stopcock ;
syringe for distending uterine dilators and injecting ; gum elastic
uterine pipe for injecting uterus ; gum elastic female catheter ;
silver ditto ; Snow's portable chloroform inhaler ; 2 4-oz. capped
and stoppered bottles ; 4 1-oz. stoppered bottles. Exhibited by
"Weiss.
The Obstetric Bags exhibited by Messrs. Khbone and
Sesemann were the following :
Eirst, bag for ordinary practice, containing : — Craniotomy
forceps ; perforator ; crotchet ; long pair of midwifery forceps ;
2 blunt hooks, large and small ; gum elastic catheter, with strong
stilette ; frsenum scissors ; Braxton Hicks' hook ; case for thread,
silk, needles, &c. ; syphon syringe, with long female pipe ; chloro-
form inhaler and bottle ; 4-oz. bottle ; 2 1-oz. bottles ; stethoscope.
Second, bag for consulting practice, containing : — Long pair of
midwifery forceps ; short ditto ; crotchet ; large and small hook ;
fraenum scissors ; Hicks' silk loop ; craniotomy forceps ; per-
forator ; long pail' of dressing forceps ; folding uterine sound ;
silver female catheter ; male elastic catheter, silver mounted ;
syphon with eleven sizes Dr. Barnes' dilating bags and long
female tube ; chloroform inhaler and bottle ; 4-oz. bottle ; 3
1-oz. bottles ; 3 scalpels ; sharp-pointed bistoury, curved ; blunt
ditto, curved ; straight blunt-pointed ditto ; 4 needles in handles ;
2 ditto, hollow for wire sutures ; silver director; spring forceps ;
3 small bulldog forceps ; silk, thread, needles, &c. ; stethoscope ;
razor, shaving-brush, &c.
Both these bags may be used as ordinary travelling-bags.
138 OPEEATINa CHAIRS OE TABLES.
Mattei's Pocket Obsteteic Case contained —
The leniceps, witli india-rubber coverings ; a stetboscope ;
scissors ; 2 bistouries, straight and curved ; female catheter ;
male catheter ; pelvimeter ; acupuncture apparatus ; 2 lancets ;
needles; ligatures.
Pa jot's Obsteteic Box, by Charriere, contained —
Laryngeal tube ; one pair of Charriere's folding forceps ; pair
of forceps for the inferior passages ; Dubois' craniotomy scissors ;
Blot's lever perforator; Pajot's cephalotribe ; Simpson's cranio-
clast, with Pajot's crotchet ; Pajot's blunt crotchet, with a thread
of silk terminated by a leaden ball, for embryotomy ; 2 Eoux's
needles for suture of the perinseum ; 6 large serrefines for the
same purpose ; Dubois' membrane-piercer ; Pajot's curette a
de'livrance of three sizes in the same handle ; Dubois' long curved
bistoury for enlarging (incising) neck of the uterus ; pair of
curved scissors for the same purpose; pointed metalHc sound
for piercing the membranes ; Donda's ergo tribe ; small silver
catheter for the infant ; silver female catheter ; long curved
trocar for hydrocephalus ; bottle for ergot of rye.
RizzoLi's Obsteteic Case contained —
Cephalotribe ; 3 pairs of long curved forceps ; perforator ;
craniotome and tire-tete ; trivella ; 2 pairs of foot forceps ; ovum
forceps ; embryotomy knife (guarded) ; pelvimeter.
Contents of Mr. Eobeeton's Midwieeey Case :
Eoberton's midwifery forceps; spear-pointed perforator; Eo-
berton's craniotomy forceps ; eviscerating knife ; blunt hook ;
uterine trocar ; foetal respiratory tube ; elastic tube and stilette ;
female gum catheter.
OPERATING CHAIRS OR TABLES.
Professor Nteop's Deliveet oe Opeeatino Table.
A very simple, cheap, and portable table for delivery (on the
back), or for operations, was exhibited by the maker. It was
invented by Dr. Honitz in 1862, and consists merely of a
mahogany board or slab, the centre of which is so cut out at
one end as to resemble the shape of a horse-shoe. There are
two foot-rests, and two legs supporting what may be termed
the ends of the horse-shoe. At the back is a screw-clamp, by
means of which it may be fastened either to a horizontal table or
OPEEATING CHAIES OR TABLES. 139
bed, or vertically to any other support. In the same way, the
legs may be lengthened or shortened at pleasure so as to heighten
or lower the table.
We are informed that in Denmark and in Grermany this ope-
rating table is very generally used. It is represented in the
annexed sketch (fig. 134), folded up and open.
Fig. 134.
140 OSTEOTOMISTS.
It is 24 inches wide and 30 inches high, and admits of being
extended into the form of an operating table, as is represented
in the subjoined illustration (fig. 136).
Fi&. 136.
OSTEOTOMISTS.
Dr. Datid Davis' Osteotomist is an instrument designed to
cut out pieces of the cranial bones. It is a powerful two-bladed
instrument with fixed scissors-joint. A female blade is fenes-
trated to the shape of the segment of bone to be removed. The
male blade is solid, and has an oblong projecting block or punch
upon its inner surface, grooved so as to make two strong cutting
edges. This cutting block is received into the fenestra of the
female blade, crushing in and taking out a corresponding piece
of bone.
Two specimens, one for short, one for long sections, were
exhibited by Dr. Hall Davis, and are figured in Dr. D. Davis'
* Operative Midwifery,' 1825, from which these two sketches are
taken (figs. 137 and 138).
Fig. 137.
OVAEIOTOMT. 141
Fig. 138.
Another Osteotomist of Dr. Davib Davis, having an oval-
shaped punch, was exhibited by Dr. Eadfoed.
Sib James Simpson's Osteotomists were exhibited by Fer-
guson, of Smithfield, and by Toitng, of Edinbui'gh.
These are right and left. They are two-bladed, working on a
fixed scissors-joint, and having the finger-rings of scissors. One
instrument is a modification of Davis's. The punch-block is,
however, wider, and square instead of grooved ; and the points
have transverse or duck-bill teeth, so as to assist in grasping like
a craniotomy-forceps.
The other Osteotome has no fenestra in the female blade, and
acts more like the scissors than the punch.
Ckanial Bone Forceps, Hamilton's. — This resembles, and
is sometimes called in the shops, a craniotomy-forceps. It is,
however, much smaller in the blades. It is constructed on the
scissors principle as to lock and handles. The blades are slightly
curved, and have transverse or duck-bill edges. It is designed
to seize and pick off pieces of the cranial bones after perforation.
It is too feeble to screw for extraction of the head. They were
exhibited by Dr. Fleetwood Churchill, Honorary Fellow of
the Societv.
Boer's Forceps, which resemble Hamilton's, were exhibited
by M. Sttlle, of Stockholm.
OVARIOTOMY, Instruments for.
A Case op Ovariotomy Instruments, including also those
for operation for vesico- vaginal fistula, ruptured perinteum, and
removal of polypi, was made for Mr. Baker Brown by Pratt,
and was exhibited by Phatt.
142
OVAEIOTOMY.
The box was of polished Coromandel wood, lined with silk
velvet. The size is about 15 inches long, 10 wide, and 3^ deep.
It contains in the lid — 2 pairs of vulsellum forceps ; 2 pairs
of Bozeman's peculiar curved scissors for vesico-vaginal fistula,
made to cut right and left ; 1 pair of long, straight, sharp-pointed
scissors ; 1 pair of fine-pointed angle scissors ; 1 pair of long-
handled, curved-bladed scissors, used in paring the inner edge in
ruptured perinaeum ; 1 pair of elbow scissors, used in ovariotomy ;
also a broad director, and a silver female catheter.
In the body of the case are two trays to lift out. Tlie first
contains 12 tubular needles for silver wire, of different curves,
each numbered from 1 to 12. They are a modification of Mr.
Startin's original tubular needle for wire sutures, but made of
tempered steel ; the original ones were soft for the purpose of
being bent to any curve, but Mr. Brown found in practice it was
better to have them firm and strong, as in some cases it requires
considerable force to get the needle through. These needles have
ivory-chequered handles.
In the next tray there were 4 long-handled knives, with the
blades bent to an angle of 15 degrees, and made to cut right and
left for vesico-vaginal fistula ; 2 similar knives, but straight.
These have plain ivory handles. A long-bladed knife, which
Mr. Brown calls his ruptured perinaeum knife, though he does
not claim any invention in the matter; a long, thin, narrow-
bladed bistoury, with a button-point, used principally in dividing
fissures of the rectum, and an ordinary broad-bladed scalpel ;
a curved probe for discovering small fistulous openings, and a
hook something like an inverted fish-hook ; a blunt hook and a
small tenaculum hook, for catching the inner edges of minute
vesico-vaginal openings and bringing them down for paring.
Fitted in to the bottom part of the case were, first — 2 pairs
of spring forceps — "long finger forceps," used for the purpose
of twisting the wire where the fingers of the operator cannot
well reach, especially where the fistula is high up and it be-
comes necessary to pass the wire through or close to the lip
of the OS uteri ; also 4 pairs of spring forceps with different points,
such as dissecting and tenaculum, fine and broad ; a pair of
artery forceps ; also a pair of spring vulsellum forceps, used prin-
cipally for seizing small tumours or removal of the clitoris. A
needle-holder, with slide, the head of which is cut inside so as
OVAEIOTOMT.
143
to be able to fix a curved needle in almost any angle, and without
which it would be almost impossible to pass the wire in some of
the more difficult cases of vesico-vaginal fistula ; 4 curved suture
needles — 1 for siiperficial sutures in ovariotomy, 1 for ditto in
ruptured perinseum, and 2 for the deep quill sutures. Also in
the same compartment a large ovarian trocar ; Bozeman's or Sims'
speculum, and a vaginal retractor. A box cut out for small
needles, extra wire, twine, quills, &c. On the lid of this box is
let in a clamp of the original form used by Mr. B. Brown, and
invented by Mr. Philip Harper. This is still used where the
actual cautery is inadmissible.
These, with two ivory reels containing silver wire and twine,
complete the furniture of this portable surgical cabinet.
The following instruments employed in Ovaeiotomt were
exhibited :
I. Clamps.
HuTCHrNsoN'a Clamp, exhibited by Ferguson, is here repre-
sented (fig. 139).
Fig. 139.
Mathieu's Clamp was exhibited by Lueb. (See his Cata-
logue, with drawing, p. 63.)
It has the curved portion of steel affixed to one of its blades,
whereby the pedicle is prevented from slipping towards the
handles.
144 OVARIOTOMY.
Fig. 140.
0
^
Dr. Ateling's Coil-Clamp, for se-
curing ovarian pedicles, invented in 1865,
' Obstet. Trans.,' 1865, was exhibited by
the author.
After the ligature of twine has been
passed round the pedicle, the two ends
are drawn through the coil by a loop
of wire. They are then drawn tight and
made fast around the cross-bar. They
may be unfastened, the coil withdrawn,
and the ligature removed by drawing at
one end at the wish of the operator
(fig. 140).
146 OVAEIOTOMY.
Dr. Clay's (Birmingham) was exhibited by Pbatt, and is here
seen (fig. 142).
Fi<j. 142,
Dr. Keassovkt's was exhibited by Professor Htjgenbeeqee.
It consists of a screw-chain 6craseur, having a separable head,
with a small screw through the eye to fix the chain when the
head is separated. The eye is expanded on each side about li
inch, to prevent its being drawn into the wound. The side
intended to be in contact with the skin is faced with ivory. (For
a drawing of this instrument see Eceasettes, page 71.)
Dr. Keassotbkt's was exhibited by Professor Htjgenbeegee.
This was a screw-ecraseur form of handle, having an expanded
head, considerably curved, with a tubular perforation on each
side of the head at the point of curvature, through which a loop
of wire passed over two small friction-wheels to the mo^ang
arms of the shaft. When the wire was tightened, it pressed
against the flattened end of the head. The inner side of the
curved head was plated with ivory, and covered with white metal,
against which the stump was cauterized.
Mr. Chambees showed his Actual Catjteet Paeallel Clamp,
which the accompanying woodcut (fig. 143) depicts. This clamp
Fig. 143.
is said by its author to possess the following advantages over
those now in use :
Ist. The great simplicity of its construction, and the perfect
ease with which it can be appHed or removed.
OVAEIOTOMT.
147
2nd. The clamps now in use, acting like a pair of scissors, press
unequally on the pedicle while the blades are being brought
together ; whereas, in this instrument, the blades being per-
fectly parallel, the pressure is applied along the whole length of
the blades at the same time, and with the greatest accuracy and
nicety.
3rd. Being a right-lined quadrilateral figure whose opposite
sides are parallel and equal, this clamp can receive and com-
pletely compress a larger pedicle than any other clamp yet
made. It has been used by Mr. Holmes Coote as well as by Mr.
Chambers, and was found to act admirably. In addition to its
value in the treatment of ovarian pedicles, this clamp may be
advantageously used in cases of omental hernia where it is
found necessary to remove a portion of the omentum ; also
in castration, haemorrhoids, vascular polypi, elongated cervix
uteri, &c.
Mr. Chambers has applied it in a case of elongated cervix
uteri for Mr. Philip Harper, who amputated with the actual
cautery. The operation was quickly performed, and without the
loss of a single drop of blood. The patient suffered little or no
pain afterwards, and was discharged cured on the twenty-third
day, having a good cervix and a most perfect os. She men-
struated fifteen days after the operation. The instrument is
made by Messrs. Mayer and Co., Great Portland Street, London,
II. Teocabs and Canul^.
Mr. Spencee Wells' Tbocae and Canula for ovariotomy,
with tube at right angles for attachment of elastic tubing, was
exhibited by Feeguson, and is here shown (fig. 144).
Fi&. 144.
148
OVARIOTOMY.
Mr. J. CooPEB Fosteh's Tbocae akd Canula for ovariotomy,
having an elastic centre of canula which can be compressed by
the finger and thumb during removal of trocar, was exhibited
by Maw and Son, and is here shown (fig. 145).
Fig. 145.
OVAEIOTOMT.
Fig. 147.
Lee's Puncturing Tuocak and Canula
was exhibited by Maw and Son, and is repre-
sented in this sketch (fig. 146).
Mr. Spencer Wells' Tubular
Trocab and Canula in one, for
ovariotomy, wherein the separate
trocar is not required, was exhibited
by Weiss, and is here represented
(fig. 147).
Mr. Chambers' Trocar and
Canula, with a movable claw for
fixing or holding the cyst in ova-
riotomy. This differs from that of
Spencer Wells', which has a claw
on each aide, but is fixed. It was
exhibited by Mr. Pratt.
The PORCEPS FOB HOLDING THE
Pabietes in Ovariotomy, as used
by Mr. I. B. Brown, were ex-
liibited by Pbatt, and are here
shown (fig. 148).
Fig. 118.
OVUM FORCEPS (vide Abortion
Instruments).
150
PELVIMETERS.
PELVIMETERS.
Baudelocqtje's Compas d'Epaisseuu was exhibited by Dr.
Ra-DFOEd. This instrument is figured in Baudelocque's work
' L'Art des Accouchemens,' Paris, 1789, vol. i, p. 88, and is repre-
sented in the adjoining sketch (fig. 149, c d). It is in shape like a
pair of callipers, and is intended for measuring the antero-posterior
diameter or other diameters of the pelvis externally. To measure
the antero-posterior diameter, the extremities of the arms are
applied, one to the spine of the last lumbar vertebra, the other
in front of the pubic symphysis, and the distance between these
is read off" on a scale placed between the two arms near the hinge.
The annexed drawing represents both this instrument as an
external pelvimeter and the internal pelvimeter of Coutouley
(fig. 149, A b).
Fig. 149.
Cotjtotilt's Peltimbtee was exhibited by Dr. Radfoed.
This instrument is intended to measure the antero-posterior dia-
meter of the pelvis from within. It is figured in Baudelocque's
PELVIMETERS,
151
' L'Art des Accouchemena,' Paris, 1789, vol. i, p. 88. The in-
strament very much resembles the rule used by shoemakers in
measuring the length of the foot, and consists of two parts, one
of which slides in a groove in the other. A spoon-shaped piece
projects from the extremity of each of these at right angles to
it. The instrument is introduced beneath the arch of the pubes
and pushed onwards until the extremity touches the sacral pro-
montory. It is held in this position, and the pubic portion of
the instrument is then slid outwards until it touches the internal
surface of the pubic symphysis. The distance of the sacrum from
the pubic bones is indicated by the extent to which the pubic
portion is then drawn out, and which is read off in inches marked
thereon. Two little handles project from the under side, and
serve to hold the instrument while the internal measurement is
being taken. Total length, 11 inches ; spoon-shaped projections,
2^ inches each in length.
The Pelvimetee of Professor E. Maettn, of Berlin, is a
modification of Baudelocque's instrument, and is intended for
the external measurement of the pelvis. The scale has the shape
of a segment of a circle, and is graduated in Paris inches. The
two arms can be readily separated at the hinge by removing the
screw, and the instrument is thus rendered very portable. It
has been used by Professor E. Martin since 1861 : see his Hand-
Atlas, plate 69, fig. 1. One specimen was exhibited by M.
LiiTTEE, of BerHn, and another by Professor Nxeop, of Copen-
hagen.
Van Huevel's Peltimetee was invented about the year 1845.
It consists of two arms, with a compass-like joint and a scale
forming a segment of a circle near the hinge. One arm is nearly
straight, having a very slight curve near its distal extremity.
This arm measures 11^ inches in length, and at about its middle
has a projecting sort of handle of a ring shape. To this arm the
scale is also immovably attached. The other arm is straight for a
distance of 8^ inches from the hinge. The remaining 3^ inches is
sharply curved towards the other arm. An extra length of 3 inches
can be given to the second arm by an arrangement like that of a
telescope slide, or it can be shortened to any required extent.
Further, at the extremity of this arm there is provision for
lengthening the arm in the direction at right angles to that of the
arm to the extent of two inches, and here there are means for fine
152
PELYIMETEES.
adjustment by a screw. The scale moves freely through a slit
in the second arm ; and when the compass is in use, the scale be-
comes immovable at any given point by slightly moving the little
lever placed over the slit through which the scale runs.
The instrument is intended for the double purpose of measuring
the distance from the sacral promontory to the exterior of the
pubic symphysis, and also the thickness of the pubic symphysis
and soft parts covering it externally. The antero-posterior dia-
meter of the brim of the pelvis is obtained by subtracting the
second of these measurements from the first. In taking these
measures, the first arm is the one which is applied internally, and
its extremity is first made to touch the sacral promontory. The
two arms are fixed at their proper places and retained in this
position until after the instrument is withdrawn, when the dis-
tance between the arms at their extremities is measured off.
During the first part of the operation the second arm is made
shorter than the first, according to the angle of inclination of the
pelvic brim ; but in taking the thickness of the pubic symphysis
the two arms should be of nearly the same length.
This instrument can be also used and applied for the external
measurement alone, after Baudelocque's manner. It was exhibited
by M. LiiEE, Paris.
Note. — A simple — probably the first — form of this instrument
is depicted in Spiegelberg's work, p. 35.
Professor Eizzoli's Pelvimeteh is a modification of Yan
Huevel's instrument (fig. 150). It consists of two principal parts,
Fig. 150.
PELVIMETERS.
153
the whole forming a compass, and connected in such a manner
that either arm can be lengthened or shortened at will, and so
fixed by means of a screw. One arm (a) measures with its handle
18^ inches. For 14 inches, including the handle, it is straight ;
the remaining 4|- inches has a slight curve. The other portion
(b) measures 12 inches ; at its free extremity it has a screw, 3^
inches long, traversing a perforation in a direction at right angles
to the arm. The instrument is adapted for measuring the pelvis
according to Baudelocque's method, or for taking the measure-
ment from the sacral promontory internally to the anterior sur-
face of the pubic symphysis. The instrument was made by the
Brothers Lollini, of Bologna.
Feegtjson's Pelvimeter (fig. 151) was constructed by Mr.
Fig. 151.
Ferguson in 1850. It consists of two straight arms of equal
length, each 5f inches long, connected by a compass-joint. A
circular scale is fixed at the joint, and is traversed by the index.
The arms are separated by means of a tangent screw. It is
intended to be used as an internal pelvimeter. The specimen
sent was made and exhibited by Mr. Feeguson, of G-iltspur
Street.
Dr. Mttbpht's is an Inteekal Pelvimetee. This instrument
consists of two slender steel rods with slightly bulbed extremities,
each 5| inches long and very slightly curved. These arms are
introduced into the pelvis, and separated after introduction by
means of two straight handles, continuations of the arms, each 7
inches in length. The arms do not cross. To one of the handles
is fixed a scale which traverses a slit in the other handle, which
thus registers the distance to which the arms are separated at
their extremities.
154
PELVIMETEES.
In form Dr. Harris' pelvimeter somewhat resembles it. It was
exhibited by Mr. Coxetee.
Dr. Habeis' Pelvimetee was constructed for Dr. Harris by
Mr. Feeguson, 1858. — This is an internal pelvimeter. It con-
sists of two arms rather sharply curved, identical in length and
so placed that when not in use the one lies in the concavity of
the other. Each arm measures 6^ inches in a straight line from
the joint to the extremity, and 7 inches round the curve ; they
are composed of thta rods of steel with bulbed extremities.
Two handles, each 4 inches long, are so arranged that by pressing
them together the arms just described are separated. The handles
are kept asimder by means of a spring. A scale graduated in inches
is attached to the near end of one of the handles, and passes
through a slit in the corresponding part of the other handle. The
scale is provided with a sliding self- registering index, which thus
marks the distance to which the distal extremities of the pel-
vimeter are separated when introduced.
The instrument is used as follows : — The two arms in close
apposition are introduced with the concavity directed forwards
until the bulbed extremity of one arm touches the sacral pro-
montory. The handles are now approximated, and the other arm
is thus brought into contact with the inner surface of the pubic
symphysis. The measure is thus taken of the antero-posterior
diameter of the brim of the pelvis.
The form resembles that of Dr. Murphy's, but the curve of
the blades is greater than in Dr. Murphy's instrument. It was
exhibited by Mr. Feeguson, Giltspur Street, and is here repre-
sented (fig. 152).
Pig. 152.
PELVIMETERS. 155
Dr. LuMLEY Eaele's Pelyimetee (fig. 153) was invented by Dr.
Fig. 153.
Earle in the latter part of the year 1860, and was exhibited at
the meeting of the Obstetrical Society, May 1, 1861 (see ' Ob-
stetrical Transactions' for that year). This instrument is as nearly
as possible identical in form, size, and principle of action with
Dr. Harris' pelvimeter above described: the one description answers
perfectly for the other.
156
PELVIMETERS.
It was made by Mr. Matthews, Portugal Street, and was ex-
hibited by Dr. Lumley Eaele.
The same instrument was also made and exhibited by Mr.
COXETEE.
Dr. Eable subsequently modified his instrument in the way
represented in this sketch (fig. 154), the blades being much less
Fig. 154.
curved, and the anterior blade made shorter than the posterior.
PELVIMETERS.
157
Dr. Gekenhaigh's Pela^imetee is here represented as in use
(fig. 155).
Fig. 155.
It is intended for measuring internally the antero-posterior dia-
meter of the pelvis at the brim. The principle of the instrument
is to assist the finger in measuiing this diameter. It consists of a
band of flexible metal one inch broad, which forms a ring. This
band encircles the hand, passing across the centre of the palm,
the size of the ring being adapted to different sized hands by a
158
PELVIMETERS.
piece of elastic india-rubber webbing. On the surface of the
band corresponding with the centre of the palm of the hand, is a
projecting pivot perforated so as to allow a small metal rod to
traverse it. The rod is 7i inches long, graduated along its central
third ; at its distal extremity is a small portion like a small seg-
ment of a ring at right angles to it, and adapted for sliding over
the finger.
The instrument is thus used : — The hand having been armed
with it, the forefinger, or the two first fingers are inserted so as
to reach the sacral promontory. The curved extremity of the
rod lies now on. the radial side of the index finger. The pro-
montory having been reached, the rod is drawn outwards until
the ring-shaped extremity is stopped by the arch of the pubes.
The distance at which the rod is thus stopped is shown on the
index, and when the hand is withdrawn the antero-poaterior dia-
meter of the pelvis can be obtained by measuring the interval
between the extremity of the finger and the extremity of the rod.
A small spring secures the rod in one position at the will of the
observer.
In another and improved form of this instrument, the palm-
piece of the instrument has on its ulnar side a scale, having the
shape of a segment of a circle of which the pivot before described
is the centre. This enables the observer to note the angular
direction of the rod at the time of the observation.
This instrument is made by Mr. "Weiss, and was exhibited by
Dr. GEEENHA.LGH.
The Pelvtmeter of Dr. Howitz, of Copenhagen, was invented
and exhibited by him at the " Philiatrie," in Copenhagen, Oc-
tober 22nd, 1861.
It is an internal pelvimeter. Two arms in apposition are
introduced into the vagina, and then separated by means of
two handles which are continuations of the arms. The whole
instrument is 12 inches long. Each of the two arms is per-
fectly straight. One arm is 5^ inches long, and its length is
fixed ; the other arm, also 5^ inches, can be lengthened or short-
ened at will to the extent of about 1^ inches by means of a rod
sliding within it. The extent of this lengthening is indicated to
the observer on a scale. On another scale, fixed to the handles,
is indicated the degree to which the arms are separated in-
ternally. The two distal extremities of the arms are connected
together in a peculiar man-
ner. A rod, or rather two
rods sliding after the man-
ner of a telescope one with-
in the other, pass from the
extremity of one arm to the
extremity of the other. This
cross-bar is so fixed that
the shortening or lengthen-
ing of the arm can readily
take place. The cross-bar
has a minimum length of
2| inches, and a maximum
length of 5 inches, capable
of increase, however, to 6
inches by screwing on an
additional piece at one end
of the cross-bar.
The instrument is used
thus : — Introduced in ap-
position, the arms are after-
wards separated, and the
two extremities of the cross-
bar brought into contact,
one with the sacral pro-
montory, the other within
the inner surface of the
pubic symphysis. The con-
struction of the instrument
allows this to be done, what-
ever be the angle of inclina-
tion of the pelvic brim, pro-
vided no hard substance
intervene between the two
points in question. To
make an observation, the
two scales must be simul-
taneously inspected, the in-
strument withdrawn, and
then reset in the same
position. The length of the
cross-bar is now measured.
160
PELVIMETEES.
and this gives the required antero-posterior diameter or true con-
jugate diameter of the brim.
The instrument is adapted for taking the measurement of the
pelvis also below the brim. It is represented in the preceding
sketch (fig, 156), and was exhibited by Professor Nyeop, of
Copenhagen.
The Pelvimeter of M. Chabriere, Presented to the
Academic de Medecine, January 14th, 1862, is here shown (fig. 157).
Fig. 157.
This instrument, constructed with the view of combining the
qualities of several pelvimeters, is very portable, folding into a
space 8i inches by 3. ,
It can be used as an external pelvimeter, after the manner of
Baudelocque's.
It can be so adjusted as to take the distance from the sacral
promontory internally to the anterior or external surface of the
pubic symphysis, after the manner of Van Iluevel's : also for
internal measurement only.
The two arms are each composed of two parts so jointed that
PELVIMETERS.
161
they move readily one over the other, opening and shutting like
the blades of a knife. One arm is provided vrith a fine adjust-
ment screw at its extremity, copied from Van Huevel's instrument.
This instrument was exhibited by M. Chabeieee, Paris.
The Peltimetee of Dr. G-ekmann, of Leipzig, was invented
by him, and was described in ' Monatschriffc fiir G-eburtsk,' Band
18, Supp. Heft for 1862.
This is a very complex and elabwately contrived instrument.
It is described in a paper of great length (22 pages), and illus-
trated by six lithographic plates in the ' Mon. f. Geb.' above
referred to. The patient is placed in a chair, to the arms of
which certain parts of the apparatus have to be attached, and
are thus made fixed points, the bases of internal measurement of
the pelvis.
The particular object which is fulfilled in the pelvimeter of
Germann is the exact determination normally of the conjugate
diameter at the brim, not an exact determination of the incli-
nation of the posterior surface of the pubic symphysis to the
sacrum. The instrument consists of seven pieces — steel rods
capable of being jointed in various ways, and which are portable —
and of a board fixed at right angles to the body round the pelvis
by a bandage.
The Pelvimeter of Professor Lazaeewitch, of Charkoff,
Eussia, was invented by him, and exhibited on this occasion for
the first time. It is represented in the annexed sketch (fig. 158).
It is a universal pelvimeter, adapted for taking the external
measurement, the internal measurement, or the external and
internal combined measurements of the pelvis. It consists of a
handle like those of a pair of scissors, measuring 8 inches in
length, 4^ as far as the pivot-joint. This handle has a curved scale
(h) attached to one ring and traversing the other. The scale folds
up when not in use. "When used for external measurement, two
arms, each a slender steel semicircular rod (a and b), are attached
to the handles, and then fixed by a simple contrivance. As thus
used, the instrument gives the external measurement of the pelvis
in any required direction.
For internal measurement two other arms are used, c and D.
Tlie arm c has a double curve ; the arm d is nearly but not quite
straight. From the pivot to the extremity, each measures in a
straight line 9^ inches. The arm c is intended to be applied to
11
162
PELVIMETEES.
tlie sacral promontory, the arm d to the interior of the pubic
symphysis. The arm d can be bifurcated 2^ inches from its
Fig. 158.
extremity (at e). "When the handles of the instrument are to-
gether, the arms c and B are in apposition at their extremities,
and they are so introduced. In separating the handles, the blades
0 and D cross, and the curve of the arms is such that the pro-
jection of the perinseum is allowed for and does not interfere with
the proper application of the two arms to the brim of the pubes
and sacrum respectively. The internal separation of the arms is
shown in the scale, and the internal antero-posterior diameter of
the brim or other parts of the pelvis obtained. The arm a is
graduated on its outer side for measuring the vertical height of
the sacrum ; also for measuring the height of the pubic symphysis.
The distance from the sacral promontory to the external sur-
face of the pubic symphysis is obtainable by using simultaneously
the arms o and a.
Lastly, the instrument is provided with an apparatus for deter-
mining the antero-posterior internal measurement of the pelris
at different situations ; e.g., at the centre of the sacrum, or at the
outlet or any intermediate point. The convex border of a semi-
PERFOEATORS.
163
circular scale is attached to the handle at its side. An index
suspended from a cross-bar parallel to the handle indicates on
the accurately divided semicircular scale the angle of inclination
to the margin of the handle, and consequently (the patient lying
flat on the back) of the line which is being measured internally
at the same moment. In taking observations by this method,
the arms c and n are used. Within this semicircular scale f, is
suspended another (g) and smaller one at right angles to it, for
the purpose of determining the angular direction of any measure-
ment made when the arms are engaged in measuring from side
to side of the pelvis internally. The mechanism of this part of
the instrument is of great delicacy. It can be readily detached
from the handle when the pelvimeter is in use for mere ordinary
purposes.
Dr. Routh's Peltimeteb was exhibited by the inventor.
This instrument consists of two sounds, but of unequal length :
on one of these is a movable pin, which, by means of a screw, can
be made to move up and down, or fixed at any point. This
sound is graduated on its inner side by the ordinary inch degrees,
which are marked 1, 2, 3, 4, &e. The other sound has along its
middle two-thirds a slit, within which the end of the pin before
alluded to may be moved to and fro. At the lower end of this
is a screw, to which is attached a transverse bar, also graduated
in inches and eighths of inches ; but, to avoid confusion, they
are marked by letters. The sounds, the upper parts of which
are very pliable, being introduced in any two cavities of the
pelvis, and bent in any manner required, are then locked, and the
position noted and marked by the transverse bar ; and when the
two parts of the instrument are removed separately, and read-
justed out of the body, as they were within it, the distance of
the extreme ends can at once be measured. This instrument
has been found to be of great advantage in the diagnosis of
fibrous tumours of the uterus.
PERFORATORS.
The instruments used within the present epoch — that is, since
modern obstetrics have been represented by a continuous litera-
ture— for the purpose of opening the foetal skull in order to lessen
164
PERFOEATOES.
its bulk, were well illustrated. These instruments belong to
four distinct forms or types, all of which are still adopted in
different countries. These leading types are — 1. The wedge-
scissors, having blades cutting on the outer sides. 2. The spear-
head. 3. The conical screw. 4. The trepan.
I. The WEDaE-ScissoES.
The earliest perforator of this form is that devised by Smellte.
It is the form most generally adopted in England and in France.
It was used by Naegele, and hence acquired use in Germany.
But of late years it has been greatly superseded in this last
country by the trepan.
The wedge-scissors differ in the form of the perforating point,
and in that of the handles.
The instrument of Smellie has the ordinary ring-handles or
finger-holes of scissors ; and the blades are long, having cutting
edges on the outer margins, and rising in thickness to the inner
margins which come in contact. They cross, in fact, like scissors.
Thus, when closed, the two blades form a spear-head for perforating.
After piercing the skull, the handles are forced apart, which opens
the blades and extends the fissure in the skull. The ring-handles
render the instrument weak, as it is difficult to push steadily or
strongly upon objects affording such an uncertain grasp.
An instrument described as Smellie' s was exhibited by Dvr-
EOCH ; another by Nteop, of Copenhagen ; another by Dr. Ead-
POED ; another by Dr. S. W. J. Meeeiman, being the instru-
ment used by his father, the late Dr. Meeeiman ; another by
Feegttsof.
Denman's Peeeoeatoe. Exhibited by Dr. Eadfoed.
In this specimen the perforating extremity of the scissors is
curved.
Another specimen of Denman's form was exhibited by Dirs-
EOCH.
Another Peefoea.toe, exhibited by Dr. Eadfoed, differs from
Denman's in having the perforating extremity straight.
Dr. Levee's Peefoeatoe is one of the scissors class. The
perforating ends are straight, terminating in slioulders. The
thumb- and finger-rings diverge, the shanks gently curving out-
wards, so that on bringing the rings together the blades open.
PERFOBATOES.
165
The divergent rings also somewhat increase the grasp during
perforation ; but still the instrument is not a powerful one.
Holmes discarded the rings, and acquired power of widening
the fissure in the skull by substituting a hinge-joint for the
scissors-joint, so that the shanks do not cross. The handles
diverging widely at some distance from the joint, when brought
together caused the blades also to diverge.
Holmes also modified the perforating point by attaching this
to one blade only, thus forming a solid spear, the opposing blade
having no point, but being truncated ; so thab when closed the
truncated blade fits under the point of the other, completing the
spear. "When the blades are made to diverge, both act in en-
larging the fissure made by perforation.
The original instruments of Holmes were exhibited by Pee-
GTJSON.
A specimen was also exhibited by Dr. Eadeoed, and this by
Weiss (fig. 159).
Fig. 159.
The modifications of Holmes' instrument are very numerous.
Dr. Geeenhalgh's Peeeoeatob is a modification of Holmes'.
The modification consists in adding to the point a triangular
ridge on either flat surface, so as to form a double or quadrangular
perforating wedge. The instrument with its several measure-
ments is here represented (fig. IGO).
Fia. 160.
In some instruments modified after Holmes and Smellie, the
166
PEEFORATORS.
divergent handles are tied at their extremities by a jointed steel
band, which, when extended, keeps the blades in apposition, and,
when folded at the joint, allows the handles to be brought to-
gether, and the blades to be separated.
Naegele's Pebfoeatoe has rather fine blades, cutting on the
outer edge, both being pointed and furnished with stops or shoul-
ders. The blades are slightly curved on the flat. The handles
are kept apart by a simple bar, attached by a joint to one
handle, so that when turned back the handles can be brought
together and the blades opened. This form has given place to
the one with the pointed steel bar. Specimens were exhibited by
Weiss and Feeguson.
Dr. Levee's Peefoeatoe was exhibited by Dueroch.
8ir James Simpson's Peefoeatoe, specimens of which were
exhibited by Dueeoch and by FEEausoN, essentially resembles
Naegele's. The blades are slightly curved. The handles are
kept open by a jointed steel bar, which forms a rest for the hand
whilst pushing or rotating the instrument in perforation. The
joint of the bar closing outwards allows the handles to be brought
together, thus opening the blades.
"Weiss's Peefoeatoe is a two-bladed wedge scissors-point with
shoulders, but differing from all the others in the mechanism
employed for making the blades diverge. This consists in a screw
concealed in a box which forms the stem. This mechanism re-
sembles that used in Burton's forceps to open and close the
blades.
By far the most powerful wedge-scissor Peeforatoe is that
of Dr. Oldham. The blades united form a strong spear-head.
The shanks and perforating ends are in one line. The spear-
head is an inch and a half long, and is divided by a shoulder from
the shank. The joint is four inches and three quarters from the
point of the spear-head. The shanks then run parallel for four
inches and a half; then they diverge at nearly right angles,
forming together a bar-rest for the hand about 3'50 inches wide,
and giving with the parallel part of the shanks a very firm grasp
for pushing and rotating. The handles, about 3 inches long, are
set at a slightly obtuse angle so as to be nearly 5 inches apart at
their extreme ends. G-reat power and steadiness are thus gained,
both for piercing and for dilating the opening.
This instrument was exhibited by Dueeoch, and also in " Dr.
PERFOEATOES.
167
Bames' Obstetric Bag," by Weiss, and is here represented
(fig. 161).
Fia. 161.
Chareiiibe exhibited a Pieece-ceaxe of Smellie furnished
Math a protecting sheath or guard, which can be removed after
introduction. This modification was proposed by Dr. Chaillt.
Chaeeieee exhibited another PiEECE-CEANE,made for Professor
Blot. It is on the wedge-scissors principle. The cutting edges
are covered during introduction by the backs or blunt edges.
It is described as " a bascule et a rotation.'^
L&EE exhibited a Blot's Pieece-ceane, modified by himself.
II. The Speae-head.
This is the simplest form of Peefoeatoe or Pieece-ceane.
A spear-head, more or less lozenge-shaped, is supported on a
strong straight stem terminating in a handle. The point of the
spear, being applied to the cranium, is pushed through it by
direct pressure on the handle.
A spear-pointed Perfoeatoe forms part of the obstetric appa-
ratus of Mr. EoBEETON, of Manchester, His instrument is
inches long. It would make a narrow slit-shaped opening about
an inch and a half long, which might be widened and broken up
somewhat by turning the handle half round when the widest part
of the spear-head was in the fissure.
Mr. Eobeeton's Peefoeatoe was exhibited by Mr. Wood, of
Manchester.
The late Dr. Wallee, of St. Thomas's Hospital, also used a
Peefoeatoe of this kind, but shorter. Exhibited by Mr.
Ddeeoch.
168
PEEEOEATOES.
Another instrument of this kind forms part of the obstetric
Teousse of Dr. Mattei, of Paris. Exhibited by Dr. Mattel
Professor Blot's Pieuoe-ceane is a modification of the spear
and scissors. It consists, in fact, of a double spear ; the two
spears lying superposed, the back of one shields the edge of the
other during introduction. The two blades form one for the
purpose of piercing the cranium. "When the cranium is pierced,
one spear can be separated from the other by a lever-handle,
thus enlarging the fissure just as the scissors does. The instru-
ment is here represented as exhibited by Chaeeieee (fig. 162).
Fig. 162.
III. The Conical Sceew.
This form is exemplified in an old instrument, said to be
Erench, exhibited by Eee&tjson. This consists in a solid screw,
cone-shaped, mounted on a straight stem.
In another instrument exhibited by Feeguson, and designed by
himself, the principles of the screw and wedge-scissors were com-
bined. It is a two-bladed instrument, terminating in a screw,
which forms the head of one blade. The perforation is elfected
by rotating the instrument, when the screw seizes and pierces.
The opening is then enlarged by making the blades diverge.
IV. The Teepan-Pjbeeoeatoe.
This is the form that appears to be most generally used in
Germany. It is obviously designed upon the model of the
trepan used in surgery for taking out pieces of the cranium in
cases of fractui'e, &c. Such a trepan mounted on a long stem, to
facilitate working in the pelvis, would represent the obstetric
trepan-perforator.
PEEFOEATOES.
169
AssALLNi seems to have been the first to adapt the trepan to
obstetric practice. His instrument was described in 1810, and
formed one of the collection submitted by him to the Institut
National de France in that year. He thus describes it in his
work — " Nuovi stromenti per estrarre un feto morbo e ribunto al
disopra d'una pelvi di cattiva forma ed angusta" (Milan, 1811).
In a first degree of difficulty, when the conjugate diameter was
under 3 inches, he used an instrument consisting of — 1st, a
canula, which he applied to the head, 2nd, a trepan, having
both a gimlet-perforator ; and a circular trepan-saw, which, passed
up through the canula, would take out a piece of bone.
This instrument was exhibited by Professor Lazzati, of Milan,
Honorary Fellow of the Obstetrical Society of London.
The next Teepan-Peefoeatoe appears to have been that
designed by Joeg, who thus refers to it (' Schriften zur Befor-
derung der Kenntniss des menschlichen Beckens, im AUgemeinen
und zur Bereicherung der Geburtshiilfe im Besondere, von Dr.
J. C. G. Jorg, JSTurnberg, 1812') : " In the preface to my ' Syste-
matic Handbook of Midwifery,' which was published in 1807, I
asked whether a head-perforator could not be constructed after
the fashion of a trepan, and be provided with a sheath." . . .
In the mean time Assalini brought out a perforator of this
kind, which is represented in the annexed sketch (fig. 163).
Fia. 163.
Jorg gave the first detailed description and figure of his in-
strument in the second part of the work first cited above, and
this is repeated in an edition of his handbook published at Leipzig
in 1833.
Jorg's instrument was exhibited by Dr. Helfee, of Leipzig.
Beaun's Teepan-Peeeoeatob was exhibited by Luttee, of
Berlin, and is represented in the annexed sketch (fig. 164).
Fig. 164.
170
PEEFOEATOES.
Another specimen was exhibited by Stille, of Stockholm.
This consists of a tube, much curved, carrying a powerful
trepan. It is worked by a winch-handle, so that it requires two
persons to manipulate. It has the advantage of being very
powerful, enough so to perforate through the face without
difficulty.
Messrs. Weiss and Son exhibited their modification of this
instrument, which is represented in the subjoined sketch (fig.
165),
Fio. 165.
Ed. Martin's Trepan-Pebfobatoeium, was exhibited by
LuTTEE, of Berlin, and is represented in fig. 166.
This is an exceedingly elegant instrument, very light and
manageable. It is figured in Martin's ' Hand- Atlas' (Berlin, 1862).
It has been used by E. Martin since 1842. It consists of — 1st.
A canula, expanded at the extremity to hold the crown of the
trepan, and narrowed below to the handle to receive the stem of
the trepan. By this means the bulk and weight of the instru-
ment are conveniently reduced. 2nd. Of the trepan, which has a
central screw to fix the crown upon the part of the cranium to
he bored, and of a circular saw. 3rd. Of a handle which receives
the quadrangular end of the stem. These pieces will all separate.
When introduced, the trepan-saw is sunk within the cranium.
After application to the cranium the trepan is protruded and
made to revolve by a backward and forward movement of the
handle.
Pig. 166.
The total length is 15 inches. The diameter of the crown is
i of an inch.
PEEINJEUM.
171
The Perforatorium of Cederschjold was exhibited by
Stille, of Stockholm.
Professor Ntrop, of Copenhagen, exhibited bis Pereoratoe,
of whicb the accompanying sketch is an illustration (fig. 167).
fiQ. 167.
It consists of a powerful trocar guarded by a canula, slightly
curved. The trocar can be protruded by pressing on the handle-
end. On withdrawing pressure the trocar is drawn back within
the canula or sheath by a spiral screw. This instrument has ij.o
power of expanding the opening made by puncture.
PERINiEUM, Instruments for Operations on.
Mr. Ellis exhibited his Plat Silyee Eibbon and New
Metallic Quills for operations on the perinseum. These were
introduced by the exhibitor in 1863. They were fully described
in the ' Lancet' for December 9th, 1865, with engravings illus-
trative of tlieir employment. The peculiarity of the exhibitor's
system is, that the flat ribbon occupies very little room, leaves
no suppurating tract, holds the structures very firmly and truly,
and is capable of being fixed by a most simple method. It is
thus applied:
" The flat ribbon of wire being passed through (two or three are
generally necessary), is secured in a very simple manner by the
peculiar arrangement of the quill which I have adapted to it.
(This is shown in fig. 168.) I have made this for my own use in
the following manner : — A piece of stout silver wire, of the shape
called ' half-round,' which may be procured at any good tool
warehouse, is straightened by a few heavy blows on a flat surface,
and then cut into suitable lengths with a file or metal saw. Place
two pieces of equal length, say two inches, with their flat surfaces
almost in contact, and then with an ordinary soldering tool run
172
PEEIN^TJM.
a little fine solder for an eighth of an inch down the two ends —
no further. In this way we have produced a metal quill with a
fine slit running through it, but closed at the ends. The flat
ribbon is passed through this sUt (formed by the contact of the
opposite flat surfaces of the wire), and it may then be made per-
fectly fast by the simple device of giving it one or two twists,
thus throwing the flat surface of the ribbon transversely across
the slit, and making it impossible to pull it through or get it
loose. This is done, of course, on both sides, and when the three
are secured we have as perfect a suture as can be imagined. For
the flat ribbon produces no suppurating tract Hke the cord or
silk, nor does it cut through the tissues like silver wire. If the
ligatures be too tight, or the parts swell much, it may be eased
by simply untwisting it by a turn or two, and it can be then
made just as secure again ; or if it be too loose, it may with the
same facility be tightened. And by having a little lateral move-
ment up and down the slit, it has a self-adjusting tendency which
is certainly not without its value. The great convenience and
cleanliness of this method of operating is one of its chief recom-
mendations, and it has this advantage in addition, that there is
not the same necessity for removing the deep ligatures so quickly
as when they are of silk or cord."
Fid. 168.
Fig. 169 represents the needle used by Mr. Ellis in these
operations.
PEEIN^UM.
Fig. 169.
173
Dr. EouTH exhibited hia Clamp to use with wires and tubu-
lar needle in perineal operations, which are represented in the
two subjoined illustrations (figs. 170, 171). It consists of 3 pieces
Fig. 170.
174
PESSARIES.
and 2 screws, besides a key to tighten tlie screws. Two of the
pieces (a, h, and h, c), are joined together by a hinge (at h). The
two ends of one of these pieces (o, h) have a shoulder at each
end {a, h) . The one at the prolonged end of the central piece,
(d,f), i.e. by a part narrowed into a screw (e,f), is perforated,
80 that wheii the screw-cap is fixed on this prolonged end it is
pulled up, and vice versa. The other end of the central piece is
secured by a notch at the bottom of the first piece (i), into which
a projecting or central piece {k) moves. At the other end of the
first two pieces another cap-screw fits and keeps them together.
Both the first and second pieces are perforated by a number of
holes placed in a line. It is clear when these are so placed a
wire will easily go through, but when the cap-screw (at y) is
tightened so is the wire, which is thus immovably fixed.
PESSARIES, UTERINE SUPPORTS, &c.
Pessauies and Sxtppobts of various kinds for prolapsus uteri
were exhibited by different makers, English ajid Foreign ; many
of tliese were of such well-known form as not to require any
special notice, such as air pessaries, Dr. Eeid's spring pessary
(Eerguson), Sir J. T. Simpson's pessary with intra-uterine stem;
that of Dr. Graily Hewitt, consisting of an india-rubber ball with
an intra-uterine stem for cases of retroflexion ; the instrument
devised by Mr. P. Mageniss which Mr. Pratt has modified by
making the stem movable ; the stem pessaries of Dr. E. Bird
(Pratt exhibitor), made of dififerent lengths, so that a portion
projecting from the vulva, the patient on sitting down conveys
additional support to the uterus, &c.
Dr. Peiestlet's Aie-ctjshion Pessaut for prolapsus uteri
was exhibited by Coxeteb, as also his Belt for anteversion, with
india-rubber pad for prolapsus.
Mr. GrBOBGE EoPEE exhibited a Tetjss Pessaet, which he
thus describes : — It consists of (1) a plug ; (2) an internal part,
with a spring ; (3) an external part, for counter-pressure.
The plug fits into the anterior vaginal pouch. On the upper
edge and posterior surface of the plug is a groove, in which the
anterior surface of the cervix uteri rests ; the point of the cervix
PESSAEIES.
175
is ilnsupported, and projects downwards into the vagina, behind
the plug. The plug is mounted on a double wire, of sufficient
length to support the uterus at its proper height. This wire is '
made of hardened metal, so as to constitute a spring, and after
leaying the vagina it is turned upwards Under the arch of the
pubis, one portion taking a curve to the right, and the other to
the left ; the two are then united in front of the symphysis pubis.
It thus forms a truss, the external part over the symphysis pubis
being a fixed point ; the internal one, by means of the spring,
with the plug attached, acts on the anterior wall of the vagina.
The pessary is maintained in position by means of the grasping
action of the spring behind, and in front of the symphysis pubis ;
but it is secured by a tape attached to it, and passed round the
pelvis, in case of accidental displacement. The wires are so
arranged that they do not interfere with the meatus, or clitoris,
on passing under the pubic arch.
The ends obtained by this pessary are stated by the author to
be as follows :
(1) It supports the uterus at its proper height.
(2) It preserves the anterior wall of the vagina of natural
length and curvature.
(3) It maintains the uterus in its normal position, with its
long axis in the axis of the pelvic brim. This happens from the
point of support being applied to the under or anterior surface
of the cervix, and not to its extremity. The uterus is balanced
on the plug at the junction of the cervix with the body of the
uterus. If the uterus slip down behind the plug (and it is quite
free to do this, as the point of the cervix is unsupported, and the
vagina is here unoccupied), its progress is arrested in consequence
of its attachment to the anterior wall of the vagina, which is now
held in its natural position by the plug and spring.
(4) The uterus cannot become anteverted. The fundus is
prevented falling forwards on the bladder by the intervention of
the upper edge of the plug, and by the gravitation of the uterus
behind the plug.
(5) The uterus cannot be retroverted, as the fundus is pre-
vented falling backwards by its connection with the anterior wall
of the vagina, and the cervix cannot turn forwards because the
anterior section of the vagina is occupied by the pessary.
(6) It prevents cystocele, or supports it if it already exists.
17G
PESSAEIES.
It does Bot distend the vagina, nor is its support obtained by
counter-pressure on the soft structures within the pelvis, the
point of counter-pressure being on the external surface of the
symphysis pubis.
Salt's CoLLAPSiNa Pessaet, for prolapsus uteri and uterine
haemorrhage, is supposed by the inventor to possess the following
advantages over the various kinds composed of unyielding
materials: — 1. The greater facility with which they can be
applied. 2. Their extreme lightness. 3. Their freedom from
odour after use. 4. Their being introduced collapsed, afterwards
inflated, and again collapsed, for the purpose of withdrawal.
The above remarks apply more or less to all inflating pessaries,
but the distinction of the invention figured below consists in the
application of a small and neatly made force-pump, which gives to
this pessary its peculiar value and efl&ciency.
This instrument it is said has been frequently employed in cases
of uterine haemorrhage, and with success. It is represented in the
annexed illustration (fig. 172).
Fig. 172.
Messrs. Maw akd Son also showed some Inflating Pessauies
which are represented in the annexed illustration (fig. 173), the
principle, that of employing air, being the same as the above.
Fi&. 173.
PESSAEIES.
177
The well-known Pessary of Zwanckb for Prolapstts Uteri
was exhibited by Maw and Son and many other makers, with
some slight and not very important modifications. The instru-
ment is represented in this sketch (fig. 174). The material em-
FiG. 174.
ployed varied, gutta-percha, ebonite, and boxwood being made
use of.
Sir J. T. Simpson's gutta-percha Table aioj Stem Pessaet
for Prolapsus Uteri was also exhibited.
Coxetek's Stem Pessary, represented in the annexed sketch
(fig. 175), consists of a vaginal portion or stem resembling very
Fig. 175.
much the end of a stethoscope, capped so as to receive the Cervix
12
178
PESSARIES.
uteri ; from the outer end of this stem are straps which keep the
instrument in situ by being connected with the belt which encircles
the abdomen.
The Hysteeophob of Nyeop (Copenhagen) consists of an
abdominal belt, to which are attached straps carrying a curved
metal rod, to which another rod terminating in a metallic ring is
loosely articulated. This ring supports the uterus. The instru-
ment is shown in the annexed sketch (fig. 176).
Fig. 176.
Dr. Breslau (Zurich) forwarded for exhibition his modifi-
cation of Dr. AVeik's Htsteeophor, The abdomen is encircled
by a bandage, to which are attached perineal straps of india-
rubber tubing, carrying a uterine support having a saucer-shaped
and perforated upper extremity.
Professor Lazakewitch, of Charkoff (Russia), exhibited his
Htsteeophob, the uterine support consisting of a rigid metallic
rod terminating in a ring and attached to an abdominal belt.
Mr. Salt, of Birmingham, sent a good Support for Prolapsus
Uteri, which is represented in this sketch (fig. 177), consisting
of a soft leather band encircling the waist, and a V-shaped strap
carrying a movable air-pad, the position of which can be very
accurately adjusted. Tlie strap is fastened to a loop in front, and
PESSARIES.
Fig. 177.
179
at each extremity the fastening consists of india-rubber rings,
which yield and render the " dead pressure" less than when
" persistent" pressure is requisite.
Professor G-ioedano, of Turin, exhibited an Elastic Spriku
Pbssabt and an Electeo-Pessabt, which the inventor considers
to be useful in cases of " prolapsus uteri, hysteralgia, Uio-lumbar
neuralgia, and similar disorders."
The Perineal Bandage devised by Dr. Gundach-Muller
for Prolapsus Uteri (exhibited by Ntrop, Copenhagen) does
not call for much description. The perineal bands are made of
leather.
There were some curiously formed Wooden Pessaries sent
from the collection of the University of Norway by Professor
Fate.
A specimen of the Pessaries for Prolapsus Uteri which are
given to poor patients at the Hospital in Copenhagen was ex-
hibited by NxROP. It consists of an abdominal belt which carries
a curved metallic rod with a cup-shaped extremity to support the
prolapsed uterus. It is made of rather rough material, but
serviceable, probably, to those whom it is intended to benefit.
The Lever Pessaries devised by Dr. Hodge (Philadelphia)
for Retroversion oe the Uterus deserve special attention. Spe-
cimens of them were sent by dilferent makers, but some obtained
direct from the inventor were kindly forwarded by Dr. Churchill,
180
PESSAEIES.
and were, perhaps, the best of the kind in the exhibition. Some
of these pessaries were made by Russell (58, George Street, Port-
man Square), without the coating of varnish ; and others (by the
same maker), slightly modified in form at the advice of Dr. Routh,
seem very valuable appliances.
Dr. Caltheop sent his instrument for Retboveesion of the
TJteeus. It has an abdominal belt, perineal strap which carries
an india-rubber support of a horse-shoe shape, which keeps the
uterus in place by being passed behind the cervix. It is also
adaptable to cases of anteversion.
Mr. CoxETEE exhibited Dr. Peiestley's Pessaet for Reteo-
and Antiveesion, which is represented in the subjoined sketches
(figs. 178, 179).
Fig. 178.
PESSAEIES.
181
It consists of a support shaped like the blade of a pair of
midwifery forceps carried on elastic perineal bands, and is either
brought to bear on the anterior or posterior portion of the
uterus.
Magenisse's Pessaet was exhibited by Mr. Pbatt, Oxford
Street, and is represented in this sketch (fig. 180).
Fig-, 180.
Meiq's Ersra Pessabt was exhibited by Messrs. Matee and
Meltzer, and is represented in this illustration (fig. 181).
Fia. 181.
a-
182
PESSAEIES.
The same maker also sent specimens of Hodge's Pessaey, of
wliicli the annexed is a representation (fig. 182).
FiGh. 182.
Pessaeies, Medicated.
A case of Medicated Pessaeies was exhibited by Messrs.
Bell aj^d Co., Oxford Street. These were made with Cacao
butter as a base, of a conical shape, like a Minie ball, and weighing
5iss each ; the following is a list of them :
Iodide of lead, 5 grains.
Iodide of lead, 5 grains. Atropine, grain.
Carbonate of lime, 5 grains.
Matico, 10 grains.
Strong mercurial ointment, 10 grains.
Bromide of potassium, 8 grains.
Iodide of potassium, 8 grains.
Borax, 10 grains.
Oxide of bismuth, 10 grains.
Tannin, 10 grains.
Alum, 15 grains.
Oxide of zinc, 10 grains.
Sulphate of copper, f grain.
Atropine, grain.
A case of Sttppositoetes was also exhibited. These were of
the same sliape as the pessaries, and weighed 3j each : of these
the following is a list :
Iodoform, 1 grain.
Strong mercurial ointment, 5 grains.
Extract of henbane, 5 grains.
PESSARIES.
183
Extract of belladonna, 1 grain.
2 grains.
Morphia, i grain.
1 grain.
li grain.
Gall, 5 grains. Opium, 1 grain.
Borax, 5 grains.
Oxide of zinc, 8 grains.
Gramboge, 5 grains.
Tannin, 5 grains.
Also some Iodized Cotton prepared for Dr. Gtbeenhalgh
for internal application to the cervix uteri. It contained — 1
drachm of iodine, 2 drachms of iodide of potassium, and 1 oz. of
glycerine, to 1 oz. of cotton-wool dried.
Mr. "W. T. CooPEE, Pharmaceutical Chemist, 26, Oxford Street,
"W., also exhibited some Medicated Vagikal Pessabies. These
were five eighths of an inch in diameter and seven eighths of an
inch in length, with the bases of Cacao butter, or Cacao butter
and olive oil, or Cacao butter and glycerine, as suggested by
Dr. Tanner.
No. 1. — Containing —
Plumbi lodidi, gr. 10 ;
Extract. Belladonnfe, gr. 3.
No. 2. — Unguent. Hydrargyri, gr. 10.
No. 3. — Plumbi Acetatis, gr. 2^ ;
Extract. Opii, gr. 3.
No. 4.— Zinci Oxydi, gr. 7^ ;
Extract. Belladonnte, gr. 5.
No. 5. — Potassii lodidi, gr. 5 ;
Extract. Conii, gr. 15.
No. 6. — Acidi Tannici, gr. 15 ;
Pulvis Catechu, gr. 7^.
No. 7. — Potassii Bromidi, gr. 10.
No. 8. — Iodoform, gr. G.
Medicated Uteeine Pessabies, two and three quarter inches
in length and one fifth of an inch in diameter, with the bases of
Cacao butter.
No. 1. — Containing —
Acid) Tannici, gr. 30.
184
PLACENTA.
No. 2.— Aluminis Sulphatis, gr. 10 ;
Zinci Sulphatis, gr. 5.
No. 3.— Unguent. Hydrargyri, gr. 25.
SupposiTOEiES containing —
Extract. Opii, gr. 2 ;
Butyr. Cacao, gr. 25.
PLACENTA, Instruments for Puncturing.
Dr. Radford showed his Long Teocab and Canula for
piercing the placenta, &c.
This instrument, which is represented in the adjoining sketch
(fig. 183), consists of a German silver canula, whose diameter
Fio. 183,
is -/jths of an inch. It is 9 inches long to the wooden handle,
and passing through and beyond it measures 13-^ inches. It is
slightly curved towards its end, which is open. There is also
an oblong oval opening on each side of the curved part ; one
near to the extremity, the other about -fths of an inch from it.
The trocar consists of a steel rod, covered by and fixed in a
German silver tube to the extent of 6| inches ; it is smooth on
its outer surface to facilitate its movements. The steel rod (when
uncovered) measures 3-2 inches. About 2-|- inches from the
handle end of this rod there is a slit in it about -^ths of an inch
long. A wire spiral spring surrounds this portion of the rod.
The other end of the rod is flat, and is slightly flexible so as
to allow of its passage through the curved part of the long canula.
Its extremity is polished, of the full size of the tube, and triangu-
larly brought to a sharp point. There is a small hole in the
handle to admit a small pin to be passed by the end of the spiral
spring, through the part of the slit in the metallic rod most
POLYPUS INSTEUMENTS.
185
distant from the handle. Bj this arrangement the sharpened
end of the trocar is always safely kept by the elasticity of the
spring, acting against this fixed small pin within the canula.
When it is intended to protrude the trocar, pressure must be
made on the button-shaped end at the handle.
*■ When used, the point of the instrument must be carried up to
the placenta, and then, pressure having been made on the button-
end of the trocar, the instrument must be pushed on and through
that organ, after which the small pin must be removed and the
trocar withdrawn, when, iu all probability, the liquor amnii will
flow away.
This instrument is a modification of that of Mr. Holmes,
which he recommends for the purpose of piercing the membranes
in order to induce premature labour.
The one just described was recommended by Dr. E-adford to
be passed through the placenta into the amnion bag, for the
purpose of gradually drawing away the liquor amnii, previously
completely detaching the placenta and applying galvanism in
some cases of " placenta praevia."
See ' Eemarks on Galvanism in the treatment of Uterine
ETseinorrhage ;' also ' Lecture on the same subject,' Provincial
Med. and Surg. Journal, 1844.
POLYPUS INSTRUMENTS.
Sir James Simpson's Poltptome oe Polypus Knife is in
the form of the usual blunt midwifery hook, with the concavity,
however, of the hook not blunt, but turned to a cutting surface
by the insertion of a piece of well-tempered steel. The in-
strument is shown in the annexed woodcut (fig. 184) : length,
Fig. 184.
10 inches ; metallic shaft, 6 inches ; wooden handle, 4 inches.
The cut represents the curved portion or hook 'at the ex-
186
POETE LACS.
tremity as somewhat wider and larger than the polyptomc
made in the first instance, and which Sir J. Simpson has since
used in practice. Perhaps an increased or a diminished size and
width of the curved hook might render the division by it more
easy according as the stalk of the polypus is very thick or com-
paratively slender.
The extreme poin|; of the instrument is blunted and rounded,
and the cutting portion or blade is so protected or concealed by
it and by the back wall of the curve, that it cau be introduced
into or withdi'awn from the vagina without any chance of the
edge injuring or dividing the vaginal structures themselves. To
be always able to discover the direction into which its hooked
extremity points after it is introduced into the vagina, the front
aspect of the handle is distinguished by having a slight knob or
other mark on it.
Dr. ATEiiNa exhibited his Poltpteite. This instrument was
invented in 1849, and modified in 1857 and 1863. It consists of
a long hook, a slide, and a screw. In using it the hook alone is
first passed over the neck of the polypus ; the slide is then pushed
up as far as it will go by the hand, and then, by means of the
screw, the operation is completed by forcing the blunt blade of
the slide into the fenestrated concavity of the hook, and through
the neck of the polypus. The flat plate is to be held by the
thumb and finger of the left hand to prevent the instrument from
rotating. It is of great consequence that the blade of the slide
should fit accurately into the opening in the hook. This instru-
ment is figured in the annexed sketch (fig. 185).
Pig. 185.
PORTE-LACS.
The Pobte-Lac of Pajot, for embryotomy, was exhibited by M.
CuAniiiKRE,and consisted of a pair of ordinary obstetric forceps, the
left branch of which was furnished with grooves in which a spring
PEEMATUEE LABOUE.
187
ending in a blunt point could be made to glide. It was designed
to carry a string of hemp or silk around the trunk of the foetus
in certain cases of presentation of the shoulder. The trunk could
then be cut through by drawing in the ends of the cord. The
construction for carrying the cord is on the principle of Belloc's
sound. The instrument is represented in this sketch (fig. 186).
Fig. 186.
A Hook with a movable conductor for carrying a hempen rope
round the foetus was exhibited by Mette, of Stockholm.
Prof Lazauewitch's Poete-Lac consists of a large, curved,
round tubular hook, furnished with a flat steel band inside, which
admits of being pushed up by a slide in the handle so as to
protrude the point, which can then be seized and brought down.
The mechanism is that of Belloc's nasal sound. It was exhibited
by the Professor.
PREMATURE LABOUR (Instruments for the
Induction of— for Puncturing the Membranes, &c.)
M. le Dr. Taeniee's instrument, as improved, was exhibited
by M. VERBrER. It consists of an elastic tube, 13 inches long,
open at one extremity and closed at the other. At the closed
or uterine end, the tube is very much thinner for about an inch
and a half, so that, on either water or air being passed into it,
this thinned portion only dilates, the remaiuder being firm enough
to resist the pressure of the fluid or air from within.
188
PREMATURE LABOUR.
It is guided into the os uteri by a whalebone stillet, 16 incbes
long, wbicb ia withdrawn after the tube is in situ. Air or water
is then used to distend the thin portion of the tube, now within
the OS, and the open or other end of the tube is immediately tied
or fastened.
Prof. Lazaeewitch exhibited a novel and ingenious syringe,
which he constructed especially for injecting fluid between the
uterus and the membranes. This syringe consists of a glass
cylinder (which is marked, so as to show the quantity of
fluid used). A twisted steel rod attached to the piston works
within the cylinder in such a manner (screw-like) that it is im-
possible for air to enter, or for the fluid to be forced forward too
violently into the uterus. There are two kinds of tubes which
fasten to the syringe, one of flexible metal, the other of whalebone.
The metal one is marked in the way ordinary uterine sounds are, to
enable the operator to know how far he has pushed it into the
uterine cavity. Its extremity is smooth and blind, but has two
oval openings on either side to allow the water to pass in a lateral
instead of an upward direction. Dr. Lazarewitch generally uses
four ounces of water at a temperature of 95° and he considers
this instrument safe, convenient, and efficacious.
Barnes's Uteeine Dilatoes were exhibited by "Weiss and
COXETEE.
These well-known and valuable appliances are made of india-
rubber in three difierent sizes, and are dilated vrith water by means
of Higginson's syringe, as shown in "Weiss's ' Illustrated Cata-
logue,' plate lii. The bags have a small thimble-like projection
at their summit to receive the finger or a piece of flat wood, for
the purpose of easy introduction into the os uteri. In shape the
bags resemble the body of a violin ; they have a long tube pro-
vided with a stopcock, which retains the fluid after its introduc-
tion.
Prof. Dubois's Pieece-membeane was exhibited by Mr. Traer.
It consists of slender whalebone, with silver-mounted joint in the
middle ; one end is furnished with an ivory point — it is altogether
about 15 inches long.
Dr. Meissnee's Insteument foe the Induction op Pee-
MATUEE Laboue consists of a fine trocar and canula, -^th. of
an inch in diameter, 18 inches long, curved its whole length, the
trocar being very sharp ; it was without any regulator, and had an
PEEMATUEE LABOUE.
189
obturator to assist its introduction. Invented by Dr. F. L.
Meisskeb, Leipzig, 1796; exhibited by his son, Dr. A. Meissnee.
Dr. EoBEET Lee's consists of a canula ^ of an inch in diameter,
slightly curved towards the end, and having a trocar adapted to it
fitted with a spring in the handle for the purpose of withdrawal.
The trocar has a regulator to prevent its projecting too far when
in use. Exhibited by Maw and by Dtteroch.
Another somewhat similar was exhibited by Dueeoch, but
without either spring or regulator.
Dr. J. Beaxtok Hicks's instrument is a canula ^th of an inch
in diameter, 9 — 10 inches long ; curved moderately towards the
end, which was laterally perforated by holes for the liq. amnii
to flow through. It had a ring at the other end by which to
hold it. A stiEet, with a regulator at the handle, passed through,
having a grooved trocar-point.
When in use the trocar-point was allowed to project about ^th
of an inch or less, while a lateral motion was given to it, so as
not to plunge into the membranes, but to produce a rent, by
which injury to the foetus is avoided. It was exhibited by the
inventor.
190
SCAEIPIERS.
SCARIFIERS.
The principal novelty in this department was probably the
instrument exhibited by M. Luee, of Paris, which in addition to
its scarifying blades had also a cupping-glass iu the shape of a
speculum attached, so that after scarification blood could be
extracted from the cervix by cupping, just as is done in the
ordinary cupping apparatus on other parts of the body.
Dr. EoTJTn's Utebine Scabificatob, made by Coxeter, con-
sists of 3 parts. A Gl-erman silver tube, dilated at its upper
end, half the upper portion of which slides upon the lower in
telescopic fashion. In the lower part of the upper portion are
two grooves, one about six times as long as the other, which
enables the one portion to be lengthened when the instru-
ment is set, a pin being fixed in the smaller one, or shortened,
when the pin is made to slide above the longer groove. By
this means the lancets may be cleaned.
In the centre of this tube two lancets, fixed on a shoulder,
which in its turn is fixed to a long cylinder, are placed. It plays
uniformly on a wire-coiled spring placed in the lower portion of
the Grerman silver tube. Its extreme end is screwed on a dilated
piece, which is kept in situ by the cap which is screwed in
its turn to the end of the Grerman silver tube. By means of the
circular screw-piece which moves up or down according as it is
screwed up or down, the depths to which the lancet may pene-
trate or scarify the os uteri is regulated.
SCISSORS.
A great variety of scissors were exhibited by various British
and continental makers ; there were straight, curved, and angu-
lar, the curves and angles varying both in degree and direction,
and involving either the blades alone, or including a part or the
whole of the handles also. These variations had reference of
SCISSORS.
191
course to the purpose for which they were made, whether to
remove morbid growths entire, or portions only of such growths
for microscopic or other examinations, or for dividing the cervix
in the non-pregnant or parturient conditions, or for the ampu-
tation of that part, or for operations higher up in the cavity of
the uterus.
M. Stille, of Stockholm, exhibited an admirable pair of
scissors, the handles being about 8 or 9 inches long. The blades
about 2 inches, and the entire instrument being curved almost
into a semicircle. It seemed well adapted for manipulations
within the uterus.
Professor Htjgbn'BEEGEE exhibited a modification of Scan-
zoNi's SoissoES, the improvement being suggested by Professor
Krassovsky. They are represented in the annexed sketch (fig.
187). It will be seen that the blades are set on at an angle, and
Fig. 187.
at the handle a graduated scale is fixed to show the extent of
divergence of the blades, and therefore the degree of incision.
It is the latter part of the instrument which was added by Kras-
sovsky. They are intended for the division of the os and cervix
in labour.
The same Professor also showed a pair of Long Scissoks of
Krassovsky, bent at the blades at an angle of about 90°. They
are for the purpose of removing portions of any deposit or growth
on the vaginal portion of the uterus, for microscopic examination
during life.
The annexed sketch (fig. 188) shows a very useful pair of scissors
which were exhibited by M. Mathieu, of Paris, and it will be seen
that the same principle of action as is there made use of can be
applied also to the manufacture of forceps : such mechanism seems
to increase the delicacy of the instrument, though, perhaps,
192
SCISSOES.
at some cost to its strength. The idea was suggested to M.
Mathieu by Dr. PfeifFer.
Fia. 188.
Mr. Phillip Hakpeb's Scissors for the removal of uterine
polypi are represented in the subjoined illustration (fig. 189).
Fi&. 189.
And Mr. Bakee Beown's Scissoes for the operation of
Clitoeodectomt are here represented (fig. 190). They are
Fig. 190.
short and strongly made, with sharp points.
SHARP HOOK (see Crotchets).
SPECULA.
193
c.
d.
e.
f-
9-
h.
i.
k.
SPECULA (see also Metroscopes).
Tlie specula exhibited consisted of three kinds, which may be
grouped together as classes. The first, A, was designed for visual
examination of the os and cervix uteri. The second, B, was
adapted especially to facilitate operations on the os uteri and
about the vaginal canal. And the third class, G, admitted of the
examination of these parts, both ocularly and digitally.
In the first division or class A, ten varieties were found :
a. Specula, consisting of 4 blades, handles, and plug.
h. „ » » » » no plug.
„ of 3 „ „ and plug.
„ „ „ no handles „ „
„ of 2 „ handles and plug.
„ „ no handles „
„ „ „ „ with plug,
cylindrical in form, and made in metal, ivory,
and glass, these being covered with india
rubber or prepared caoutchouc.
In the second class, 8 varieties were shown, and in the
third, G, there was but one specimen.
CiA-SS A.
a. Dr. Datid Davis, 1830, exhibited by Dr. Hall Datis.
The upper and lower blades overlap and embrace the lateral
ones ; they are all simultaneously opened by closing or drawing
together the handles, between which a screw is placed to regulate
the desired amount of separation of the blades. A chain, 5 inches
long, is fastened to the extremity of each handle, and by holding
this the patient can retain the instrument in situ, sbould the
operator otherwise require the use of both hands.
a. Professor Ricokd, Paris, 1836, exhibited by Lueb, of Paris,
and Maw aitd Son. The blades have the same arrangement as
in Dr. Davis's, but the plug is retained by means of a spring and
is released by closing the handles, by which also the blades are
opened.
13
191.
SPECULA.
a. Professor Q-io-Batta's, Bologna. Two of the four blades
are shifting, so that the instrument may be used as a bi- or tri-
valve speculum. The handles are folding. The blades can be
opened either by closing the handles, or gradually by turning a
small screw placed at the junction of the handles with the blades.
I. Eicobd's, made by Lpek, exhibited by Dueroch. This
speculum, like Professor Gio-Batta's, has two movable blades,
which -are kept in place by springs, and thus differ from the
professor's, which are fastened by small steel nuts. The blades
are opened by closing the handles.
c. Madame Boivin's, exhibited by Lueb. The third or upper
blade folds within the two lateral ones ; they are all opened by
closing the handles, which are attached to the lateral blades. A
screw is placed between the handles, and by this the blades are
kept open.
c. Sir James Simpson's, exhibited by Young, of Edinburgh,
and Maw and Son (fig. 191). The third blade lies within the
Fig. 191,
two lateral ones, as in the preceding instrument. They are opened
by closing two short handles, which fold up by the sides of the
lateral blades, and so makes it very portable. It is a modification
and improvement of Madame Boivin's.
c. In M. Stille's, of Stockholm, the two upper blades are
opened by a long screw which works under the handle of the
instrument ; this handle is formed by the prolongation of the
third blade.
c. Eig. 192 shows an American speculum exhibited by JMaw
SPECULA.
195
AND Son. The blades are expanded by turning the screw placed
at the under surface of the handle, which is a continuation of the
third or lower blade.
Fig. 192.
d. A very curious variety of the tri- valve speculum, exhibited
by Professor Beeslatj, of Zurich. It is one of the terrible but
historically curious specimens described and illustrated in the
now rare book of P. Rueff, ' Ein schon Iseserg Trostbiichle von den
Empfeugknessen eft.,' Zurich, 1554. Eueff lived in Zurich in the
middle of the sixteenth century, and his book, translated in several
languages, was one of the first concerning the obstetrical art.
The blades of this instrument are pointed, 3 inches long, and
spring at right angles from the handle, which is heart-shaped and
has a long screw running through its centre ; this screw, attached
to the blades, is turned by another handle similar in construction
and movement to those used in the common street organs. Dr.
Breslau writes to us as follows :
" Eight years ago I bought this iron instrument from an anti-
quary who had received it as a legacy from a physician, and I
believe, judging from its form and construction, that it is an
original one. I should be most happy if the Obstetrical Society
196
SPECULA.
of London would not only take an interest in tbis specimen of
mediajval obstetrical cruolty, but more if they deem it worthy of
a place in their collection." The instrument is accordingly in
our museum.
d. Dr. Mathews Dtjkcan exhibited also a very ancient Specu-
lum, in all respects like the above, with the exception of the
blades being rounded at their extremities, and 4|- inches in length.
d. Weiss's Spectjltjm, 1823. The blades are narrow and long ;
they are placed at right angles to the handle, which is in one
piece, and contains a screw : by turning round the handle the
blades are separated.
d. "Weiss's Specultim and Dilatoe, 1823. A similar instru-
ment, with thinner blades, and capable of dilating the female
urethra, or a constricted vagina.
e. Coxetek's Scbew Leyeb, 1850. The blades are 6 inches
long, edges thin and well rounded ; they each terminate in a ball
point.
f. Eiooed's, exhibited by Luee. The blades are 5^ inches
long, and liave a graceful outward bend from the head to their
extremities ; they are separated by closing the handles, and are
kept open by a screw attached to the handles.
This instrument is represented in the adjoining illustration
(fig. 193).
Fig. 193.
g. Eicoed's, exhibited by Dueeoch. This Speculum is gilt^
the blades unite closely in their whole length, are narrow, measure
5 inches long, and are duck-bill in shape. The liandles open the
blades, and are folding.
g. Dr. Cusco's, 1863, Messrs. Weiss. Blades are 1\ inches
wide and 4 inches long ; flat externally and internally. Each
blade has a handle attached to it, and they are opened by drawing
the handles together, while a screw running through one of the
handles regulates the degree of separation.
SPECULA.
197
g. An almost similar instrument, also by Dr. Cusco, was ex^
hibited bj Luee. The handles are folding for convenience in
carrying, and the screw is at the side of the blades.
g. Dr. Geailt Hewitt's, was exhibited and made by Peatt.
This speculum is a modification of Cusco's. The width of the
aperture is a little increased in order to render the instrument
better adapted for operative procedures, and the handles of the
instrument are so fixed that it is more portable.
li. Dr. Ttlee Smith's, made by Weiss. The blades are opened
by the screw lever ; they are in close apposition, and round at
their uterine extremity ; they are concave internally, and measure
nearly 5 inches in length, by 1^ in width. Fig. 194 shows this
speculum, together with Dr. Tyler Smith's Endoscope.
Fig. 194.
ment in this instrument consists in substituting a powerful screw,
action for the large handles of the original speculum. The lever
198
SPECULA.
action consists of a small male screw which is hinged to the
lower blade, and a fly-nut with spherical bearing. This mechani-
cal arrangement gives considerably more power than those of
other specula hitherto made, and is at the same time quite
out of the way of the mouth of the instrument. Another im-
portant point about this speculum is that though the two blades
meet at their extremities, there is a fenestra on either side which
prevents the nipping of the vaginal wall, when closing the in-
strument for its removal : its entire length is 4!^ inches.
i. Messrs. Weiss also exhibited a beli,-mouthei> Speculum
as described in their catalogue of 1863, plate xxviii.
*. Also a similar instrument with their improved screw action,
as applied to Cusco's speculum ; by both these instruments an
extensive view of the parts can be seen, owing to the width of
the mouth, vphich is 2^ inches in diameter, and round in shape.
i. ScEEW-LEVEB SpECULUM of CoxETEE, 1846. The dilatation
of this instrument is efiected by means of a screw lever. The
shape of the blades is such, that when expanded, the vaginal
folds will not fall in and obstruct the sight. The instrument can
be thrown completely open, and thus readily cleaned. It is very
portable, and, when required, is fitted with a plug, so arranged
as to contain caustic case, lancet, and sponge-holder, and fitted
in a neat leather case the size of the speculum (fig. 196). —
a. Dilating blade, b. Frame embracing the blades, d. Screw
bearing on the lever wbich opens the blades.
Fig. 196.
i. From Lisbon, 1830, invented by Joaquin da EocnE
Mazarem. a very curious instrument; the two blades open
SPECULA.
199
parallel to each other, one being raised from the other by means
of a screw, as shown in the woodcut (fig. 197) .
Fig. 197.
The principle of this speculum is good, as the external opening
is equal to the uterine, admitting of the same space from one ex-
tremity to the other.
i. Dr. Henry Beknet's, was exhibited by Coxetes and by
Maw and Son (fig. 198). The blades are flattened at their
uterine extremity, and are opened by the ordinary screw lever.
Fig. 198.
k. Professor Lazakewitch's, of CharkofF, Russia, was exhibited
by himself. Made of brass or zinc, covered on the outside with
200
SPECULA.
black and on the inside with white varnish. Such a speculum is
very durable, may be kept clean, and admits of accurate and
clear lighting of the inspected object. The form of the speculum
is cylindrical ; the inner end of it, intended for introduction, is
cut obliquely, and the edge turned shghtly inwards ; the edges of
the outer opening are bent outwards.
k. Peeguson's Ivoet Speculum. This is well adapted for
the use of the actual cautery to the os and cervix uteri.
k. Feeguson's Glass Speculum, coated over with a thin
layer of india rubber. This instrument is a very useful one,
possessing great reflecting power, and capable of always being
kept perfectly clean and bright ; for ordinary use, Dr. Churchill
has foimd this speculum (of difiereut sizes) the most useful.
Class B.
These specula are intended more especially for examinations
and operations about the vagina.
I. Dr. Maeion Sims' Duck-bill Speculum, exhibited by
Messrs. Mayeb akd Meltzee (fig. 199), may be considered to
Fig. 199.
hold the first place. It is formed oi metal and is generally electro-
plated, between 8 and 9 inches long ; both ends turn in the same
direction, one being smaller than the other ; they are both sections
of a cylinder, the concavity looking outwards.
SPECULA. 201
1, Mt.Peatt's modipication of Sims' Speculum (fig. 200).
riG. 200.
This valuable instrument is rendered very portable and more
easy of application. By means of a central screw the two blades
divide and fit into a small case, and instead of both blades turning
in the same direction, they are in shape, when together, some-
what like the letter Z : for practical purposes this is thought to
be a great improvement.
2. Dr. Tahnee's Speculum, made and exhibited by Pbatt,
is here represented (fig. 201). This is a double spoon-bowl
Fig. 201.
speculum, jointed at the handles so as to open like a pair of
202
SPECULA.
scissors; the handles are at right angles to the blades, which
are kept open by a set screw. It is useful for exploring the
vagina where fistulsB exist or are suspected, and also for small
operations in this locality, as by its bulbous extremity and
narrow neck it keeps in situ without assistance.
3. Hilliaed's, exhibited by Feeguson. This speculum is
composed of 4 flat pieces of metal, the two inner folding within,
the outer like an inverted capital M ; when opened by means of
the handles and a screw placed between them, the blades form
three sides of a square, thus u.
4. A Speculum was exhibited by Dueeoch, and considered
to be of American origin It consists of four rods, each bent at
their uterine extremity; they have each a separate screw, by
which any single one may be extended upwards and downwards
without any movement of the others ; there are two handles,
which are so fixed as to open the blades laterally. By means
of this instrument the whole vaginal canal may be seen with
perfect ease,
5. Beaumont's, of Toronto, was exhibited by Feeguson.
This instrument has a horse-shoe base, from which five blades
slide at right angles ; each blade is 4 inches long and \ inch
wide ; they each have a screw which regulates their opening,
each blade having to be opened separately.
6. The Vaginai/ Eeteactoe of Dr. Simok, of Bostoek, ex-
hibited by M. Stille, consists of two handles, one 11, the other
8|- inches long, each curved at one extremity, and at the other
having a spring so arranged as to seize one of six different-sized
blades, some concave and resembling Dr. Marion Sims', others
perfectly flat.
The object of this instrument is the same as Dr. Sims', but it
is thought to be an improvement on his in having the handles
separate and longer, by which the instrument can be held in situ.
perfectly free for any operation.
7. A CuEVED Vaginal Spatula of M. Jobeet, of Paris,
1845, was exhibited by Luee. This consists of two separate
blades with wooden handles, each having a different curve. One
of the blades is quite flat, and 6 inches long ; the other resembles
a duck's bill, and is 5^ inches long.
8. Mr. Feeguson exhibited two Vaginal Eeteactoes Avith
blades both alike, 5 inches long, and having their external surface
concave.
STETHOSCOPES.
203
Class C.
I. Dr. Photheboe Smith's was exhibited by Mr. Eerguson,
in a case with caustic holder and scarificator.
This Speculum consists of two cylinders, the inner made of
glass, covered with india rubber, the outer of metal gilt, having
an oval aperture of nearly 3 inches long at its lower half. After
the instrument is introduced, the inner speculum is withdrawn
entirely or partially, and the finger can then be passed externally
along the vaginal wall, through the fenestrum, to the os and
cervix uteri, thus combining the advantages of a digital and visual
examination.
SPONGE-HOLDERS (see Miscellaneous).
SPONGE-TENTS (see Miscellaneous).
STETHOSCOPES.
Dr. Mattei exhibited a very portable form of Stethoscope.
The materials of which it was composed were caoutchouc and brass,
the latter forming, as it were, a framework for the former. The
end to be applied to the ear consists of a circular plate of brass,
which works on a sort of pivot, so that it may be folded flat and
parallel with the length of the instrument, and the same applies
to the other end of the instrument ; so that when both ends are
thus turned down, the entire instrument becomes quite flat, and
but for its length might go into the waistcoat pocket. The
centres of the two extremities are connected by means of a brass
wire or rod, and upon this the ends turn by joints. When the
ends are turned so as to be horizontal and at right angles to the
tubes, the intervening caoutchouc case is put on the stretch, and
then its shape resembles that of our ordinary stethoscope, the
brass framework not being seen. The end applied to the chest
is infundibuliform, and the whole instrument forms a sort of
acoustic chamber. By an ingenious contrivance in the shape of
a tube affixed at the side for insufilation, the caoutchouc walls can
be tightened at will by blowing into the instrument ; this renders
it still more delicate as a measure of sound.
204
DOUBLE STETHOSCOPES.
Professor Kuneke exhibited his Double STETnoscoPE foe
THE DIAGNOSIS OE TWIN PBEGNANOT. It COnsists of two india-
rubber tubes, one for each ear, the opposite ends being placed over
the gravid uterus. Then, by comparing the frequency, force, and
especially the locality of any given sounds, the diagnosis is
arrived at.
SUPPOSITORIES (see Pessaries, Medicated).
SYRINGES (see Douches, Enema Syringe, Mis-
cellaneous, and Instruments for the Induction
of Premature Labour.)
TIRE-TIJTES.
205
TIRE TETES.
These compound instruments combine the pebjobatoe and
EXTEACTOE.
AssAiiKi again sets the pattern of these. His trepan-perfora-
tor being withdrawn from the canula after having taken out a
piece of bone, he then passed through the canula a sort of key or
olive consisting of a bar, which, when admitted into the skull,
could be made to stand at right angles to the stem ; it was then
rotated to break up the brain ; and next laying across the opening
in the skull it served to draw the head down into the vagina.
"When in the vagina, he seizes the head with his fingers. The
instrument had therefore no great power as a tractor. In cases
requiring more power he used his compressor-forceps, or the fol-
lowing contrivance, which he thought was especially adapted to
the extraction of the head when left behind in the uterus sepa-
rated from the body. This was a kind of anchor which was passed
through the same canula which had served for the trepan.
Branches then opened and spread out inside the skull. To the
shank was attached a string upon which traction was made. (See
* Nuovo Stromenti,' &c.)
The TiEE-TETE of Professor RizzoLi is represented in this
sketch (fig. 202). As will be seen, it is also a perforator, the tire-
Fia. 202.
tete being formed by the cross-bar portion, which is placed at
right angles to the shaft of the instrument by pulling down the
ring represented on the upper part of the drawing.
A NEW Peeeoeating-teactoe by F. W. Dunne, M.E..C.S.
was exhibited by Mr. Dunne. It is an instrument designed on
the same principle as Assalini's. After perforation, a shifting
206
TRANSFUSION.
bolt causes two or four blades to expand witliin the cranium at
right angles to the stem. These blades thus resting in the
cranium form the anchor-like hold for traction.
In another instrument, exhibited by Pebguson, a Sceew Pee-
roBATOE is combined with a crotchet or anchor-like extractor. A
strong perforating screw terminates a straight stem. Below the
screw is an anchor-like crotchet which lies flat in contact with the
stem until perforation is effected. Then, by means of a sliding-
bar running along the stem, the anchor can be made to project at
right angles, taking a hold inside the skull in order to extract.
This curious instrument, reminding one of Assalini's contrivance,
was designed by a provincial sUrgeon who gave it to the late Mr.
Earle, of St. Bartholomew's.
The Tiee-tete of G-regoire was exhibited by Dr. IMatthews
Dtjfcan, Honorary Fellow of the Society.
Dr. E. "Wallace Johnson^s Teactoe is similar in principle
to Assalini's anchor- tractor. It is called a " blunt-hook." It
consists of a slender stem, terminating at one extremity in a curve
having an eye ; at the other bearing a transverse bar set on a joint
which admits of the bar being folded so as to form a line with the
stem, and thus allowing it to be introduced through an opening
in the cranium. When inside, the bar rides away from the stem,
and stands at right angles with it, taking a hold on the inner sur-
face of the cranium.
THANSFUSION, Instruments for.
Prof Maetin, of Berlin, exhibited his instrument, which con-
sists of a small flattened trocar and canula for puncturing the
vein, the canula being adapted to the syringe.
Dr. AVELtNO exhibited his apparatus for immediate transfusion,
described by him June 1st, 1865, ' Obstetric Transactions.' It
consists of a small elastic tube having a dilatation in the middle
without valves. To each end of the tube is attached a small silver
tube to enter the vein. After opening the veins of the giver and
receiver, one end is inserted in each. It is proper to place the
tube in water first, and by compressing the dilated part to expel
all the air. The plate (fig. 203) explains the mode of using.
208 TEANSFUSION.
Dr. Gbailt Hewitt showed the apparatus described by him
in * Obstetrical Transactions,' 1865. It consists of a glass syringe
holding two ounces, into which the blood is directly received.
The piston is taken out, the open end inverted over the opening,
the edge pressing firmly on the proximal side of the vein, while
the distal side is scarcely at all so, only sufficiently to prevent
the blood escaping. When sufficient blood is received into the
syringe it is immediately removed, the piston applied and the tube
inserted into the end of the canula, which has already been placed
in the vein of the patient in the usual manner.
Fia. 204.
TEANSFUSION.
209
The case contains the syringe, two canulas with plugs, a pair of
small dissecting-forceps, a sharp cutting scalpel, and common
lancet.
Dr. Eahle exhibited his modification of Dr. G-eailt Hewitt's
TEANsrusiOjS" Appabattjs.
Fig. 205.
The author states that, during the filling of the glass syringe
with blood, it is absolutely necessary that it should be held in the
horizontal position, as recommended by Dr. Grraily Hewitt. If it
were to be held vertically, the blood which first issued from the sup-
plying
vein would at once pass into the escape-pipe, and be liable,
from its coagulation, to obstruct the subsequent injection of the
blood. It might be held inverted over the arm of the person sup-
plying the blood, and the blood be allowed to well up into it, but
there would be the risk of losing the blood either from the mouth
14
210
TRANSFUSION.
of the syringe not fitting closely to the surface of the skin, or
from the individual fainting.
It being, therefore, a sine qua non that the syringe should be
held horizontally, Dr. Earle has added a small movable funnel
to the mouth of the syringe, for without it it vrould be impossible
to fill the syringe in a horizontal position ; the blood would flow
out as quickly as it passed in. Next, he has substituted a stop-
cock for the stopper to the orifice of the escape-pipe. When the
syringe is suificiently filled the stopper has to be removed to
enable the canula to be inserted, and, in consequence, a certain
amount of blood is lost. This is prevented by the stopcock. Be-
sides, the stopcock can be worked with the canula already ap-
pended to the escape-tube, which would save a little of the time
which is so precious in this operation. The stopcock has been
made in such a manner that the calibre of the escape-pipe has
not been in any way diminished. Lastly, he has had the escape-
pipe removed from the centre and brought as near as possible to
the margin, in order to prevent any blood from passing into the
escape-tube until a short time before the injection is actually
commenced — a point upon the importance of which it is needless
to comment.
211
UTERINE SOUNDS.
The uterine sound, it may be J'lO- 206.
thought, is too simple an instru-
ment to admit of much variation.
Jfeverthelees, there were some
modifications, of which the follow-
ing were the most noteworthy ;
mere differences in size, in curve,
in length, &c., it is scarcely neces-
sary to remark upon.
Dr. Lttmlet Eable exhibited
a modification of the TJtebike
SoTTiTD, in that it was jointed at
about 2^ inches from the ex-
tremity. The instrument, which
is represented in the annexed
sketch (fig. 206), is not intended
to supersede the common sound
in ordinary cases, but is thought
to be specially useful in re-
storing the retroverted or anti-
verted uterus to its proper posi-
tion in a natural manner, with-
out twisting the misplaced organ.
At the handle end of the sound
is a screw, by means of which
the jointed portion is put in
motion at the other extremity,
and so can be made to form
either a right angle with the
shaft, or any other angle between
that and the straight line.
The instrument was invented
by Dr. Earle in 1864, and is
described in the ' Medical Times
and Q-azette,' June 18th, 1864.
The TJteritte Scran of Pro-
fessor LAZAnEwiTcn consisted of
a steel rod 9^ inches long, the
two ends of which were bent in
opposite directions in the form of
212
TJTEEINE SOUNDS.
the letter S ; one end was shaped like the ordinary sound, the
other was flattened like a small oval spatula. The former was
measured off into centimetres, and opposite the 6th, 7th, and
8th centimetres were three small elevations, while opposite the
9th, 10th and 11th were notches ; these differences heing intended
to facilitate the measurement of the uterus without the with-
drawal of the sound. The spatula-shaped end readily indicated
any change in the direction of the instrument, and, more than
that, according to the author, if the handle is introduced into the
cervical canal, and by its means the anterior is separated from
the posterior wall, then it is possible to see either of them on
the polished surface of the concave side of the handle. Thus,
the instrument becomes also an intra-uterine speculum.
Professor Haabkb, of Leipsic, exhibited an instrument jointed
in precisely the same way as that of Dr. Earle, with this ex-
ception, however, that, though jointed, there was no means of
acting upon this when introduced. The joint was a simple hinge-
joint, and was unconnected with any screw for its adjustment.
Dr. J. Maeion Sims' Uteeine Sound is represented in this
sketch (fig. 207), with what he calls his TJteeine Peobe, which is
Fig. 207.
the innermost and more curved of the two. It is made of virgin
silver or annealed copper, silvered, smaller than the ordinary
sound, and without notches. They are represented here as the
natural size.
VACCINATOE.
213
VACCINATOR.
A most ingenious iastrument for vaccination, invented by M.
Chassagnt de Ltou", was exhibited. It was about the size and
had much the appearance of an ordinary pocket pencil-case or
penholder. At one end of it was a small brass tube about half an
inch long, somewhat pointed ; its internal diameter was of almost
capillary fineness, and it was observed that on pressing this glass
end of the instrument upon the hand, the glass portion receded by
a sort of spiral spring within, in doing which it exposed two ex-
ceedingly minute steel points, looking each about the size of the
sting of a wasp, and correspondingly sharp.
The use of the instrument was thus explained : The little glass
tube is first charged with vaccine by capillary attraction, by merely
placing it on the punctured vaccine vesicle. Thus charged, the
same end is pressed upon the arm to be vaccinated, the glass re-
cedes, the two little steel fangs protrude, and are forced into the
arm, carrying with them the vaccine by which they are surrounded
in the tube, and the operation is complete.
The instrument is at once ingenious and efiective.
VAGINOSCOPE.
Dr. Rottth's Yaginoscope, made by Coietee, consists of four
parts : 1. A vaginal-end shaped like an ordinary speculum (e). 2.
A cup-shaped end (a). 3. Between the two a circular piece (b),
on which may be placed a tense membrane. 4. To the end of the
cup-shaped portion an elastic tube, or a solid tube bent at right
angles and terminating by an ear-piece, as in ordinary stethoscopes,
may be placed. Pig. 208 represents these parts.
If the vaginoscope is made of glass (as in that made by Maddox),
it is bent upon itself, and the distal end bevelled ofif, as is repre-
sented in the above sketch.
214 VECT18 OE LEVEli.
i'^XG. 208.
VECTIS OR LEVER.
Two specimens of Dr. Bland's were exhibited, one by Dr.
CoEY, the other by Dr. Matthews Duncan, date 1794. This
instrument consists of a flat piece of steel, 15 inches long, about
■jifyth inch thick, and 1^ inch wide, rounded off at each end, one
of which is rather wider and fenestrated.
A Vectis teactoe, of a very early period, was exhibited by Dr.
EADrOED.
It had the ordinary handle and shank, but the blade was about
1 inch wide equally throughout, i inch tliick, 5 inches long, with-
out any fenestrum, and well curved throughout its whole length.
Another Vectis teactoe of early form was exhibited by Dr.
Eadeoed ; it was similar to the last, except that the blade was not
of equal width throughout, but dilated gradually till it rounded oft'
at the end.
Aitkin's " Lining levee" was exhibited by Dr. Mattuews
Duncan.
VECTIS OE LEVEE.
215
The upper half of the blade is capable of being made straight or
bent at any point between the ordinary curve, by a joint which was
acted upon by a screw, running up the handle shank and lower
part of blades, which was covered with leather — about 1784.
Vectis, of Dr. Diegee, 1833, was exhibited and made by 'Nr-
EOP, Copenhagen ; it was of ordinary form, excepting in two par-
ticulars. Eirst, the end of the blade, instead of containing the
ordinary curve, which it had observed to within an inch of the
end, turns slightly back. Second, the handle is divisible into two
parts, one of which can be attached by a ring to the shank, and
with a joint to place it at any angle to the same.
The Vectis tbaotoe of Dr. TJvEBAiiE West was exhibited
by himself
This vectis is proposed by the inventor as being likely to possess
all the advantages of the ordinary vectis, with the addition of some
of those of the loop ; the principal modification consisting in a
greater width of blade, or rather of fenestra, so that a considerable
breadth of the foetal head is grasped by it, as well as hooked, so to
speak, by the beak. Erom possessing a more slightly curved
beak than the vectis in ordinary use, Dr. Uvedale "West remarks
that it is more easily iatroduced, while, in consequence of an ap-
preciable breadth of the head sinking into the fenestra, it is even
less likely to sKp. Eig. 209 represents the instrument flat, and
fig. 210 in profile.
Fig. 209.
Two Vectes of Professor Fabbei, of Bologna, were exhibited
by himself. Both were of the same width of blade, length, and
size of fenestrura. The shank and lower half of the blade curving
216
VECTIS OE LEVEE.
backwards in both ; but in one the upper half curves forwards,
while in the other it becomes straighter, but does not curve
forwards.
Dr. Ogden's (of Manchester) Tractob or Vectis was 16
inches long, having a joint between the shank and the handles ;
it was considerably curved near the upper end, which does not
80 gradually widen as the ordinary fenestrated forms ; but within
3 inches of the end it rather quickly expands into a blade, 2^
inches at its widest part, with an almost oval fenestrum.
The accompanying illustration shows the general shape and
form of the instrument, the degree of curvature, and the position
of the opening.
Fig. 211.
A Vectis, modified by F. Symonds, Esq., was exhibited by
COXETEB.
It had a joint at the junction of the shank with the handle, the
blade being much curved.
A Vectis with joint in the same position as the above, a very
early specimen, was exhibited by Dr. Coet.
The ordinary forms of cueteb eenesteated tectis were ex-
hibited by Drs. Coey, Eadpoed, Coxetee, and many others.
One of those of old date exhibited by Dr. Coey possessed two
holes between the shank and fenestrum.
The Letiee tubule (perforated vectis) was exhibited by Chae-
EiEEE, and was invented by Dr. Maetix-delaplaque.
The blade was gently curved and tubular, having apertures on
the convex face and inside of the fenestrum ; the shank and handle
were also tubular to convey fluids. Length 15 inches, shank and
handle 12^ inches, widest part of blade 2 inches.
VESICO- VAGINAL FISTULA.
217
VESICO- VAGINAL FISTULA, Instruments for.
Many very ingenious instruments connected with this opera-
tion were exhibited by various authors and instrument makers.
Their ingenuity being displayed partly in. the instrument used for
preparing the edges of the fistula, but chiefly in the means by
which those edges were either brought together or secured.
Hence a variety of very clever contrivances in shape of needle-
holders, wire-adjusters, clamps, &c., employed in this operation.
- Dr. Maeion Sims exhibited in this department a tenaculfm,
BLUNT HOOK, wiEE-ADJTJSTEE, and KEEDLE-HOLDEE, all made by
Messrs. Maybe and Meltzee.' The latter instrument consisted
simply of a pair of long forceps, the blades being flat, closely op-
posed and dentate, so that they secure a firm hold of the needle
between the teeth, and by a simple catch at the handle the two
limbs are locked together, and the forceps and needle thus be-
come, as it were, one instrument, which can be manipulated with
facility.
His wiEE-ADJUSTEES were made of different forms ; some resem-
bled a miniature fork, the wire passing between the prongs ; others
were small circular disks of metal, the wire passing through a
hole made in the middle of the plate ; all being fixed in long
handles for the convenience of the parts operated upon.
The Blunt-hook consisted merely of a small probe-pointed
steel rod, turned nearly at a right angle. This instrument is in-
tended for the manipulation of parts which the finger either can-
not reach, or only with great difficulty.
The TENACULUM is a small delicately fine-pointed instrument,
the point being at right angles with the stem, for the purpose of
hooking down any parts within manipulation reach.
Some instruments of a similar kind were exhibited by M. Still^ ,
of Stockholm, together with some ingenious needles fitted with
long handles, their extremities being bent at various angles and
notched on one side so as to carry the wire easily through the
parts without being actually threaded before introduction, the
advantage of this being the facility with which the wire can be
inserted and the needle withdrawn from the parts. Thus the
needle is first passed through the part to be sewn, then, while
218 VESICO-YAGINAL FISTULA.
in situ, the wire is passed into the notch, and by withdrawing the
needle the wire is drawn through and so fixed in the parts.
Dr. Beaumont's Needle for vesico- vaginal fistula is repre-
sented in this illustration (fig. 212).
Fig. 212.
Dr. F. Bird's needles for vesico-yaginal fistula, were ex-
hibited by Pbatt, Oxford Street.
Fia. 213.
r ^
The engraving shows one of these (they are made right and left),
with a cross handle, and provided with a notch close to the point.
Dr. Bird prefers to close the edges of the wound in vesico-vaginal
fistula, without the aid of a speculum. Thus with one of these
needles in one hand and the finger extended towards the point, he
is able to pass the needle through the edges of the wound ; then
with the forefinger of the other hand he carries up the wire and
hooks it on to the point of the needle, then by a quick backward
movement of the needle the wire is pulled through. The object
sought is not unduly to stretch the parts, as may be the case
where the speculum is used.
Dr. AvELiNG showed his shot-punch. By means of a screw
a piece of hard steel wire is made to perforate a shot. The in-
ventor uses pierced shots to secure sutures m vaginal opera-
tions.
VESICO-VAGINAL FISTULA.
219
He also exhibited his coil clamp. This little instrument was
invented in 1863, to render the removal of sutures in vaginal
operations more easy. It is made by winding a piece of ordinary
iron wire (No. 28) round a pin, until a coil half an inch long is
made. The ends are then cut off smooth. When the suture has
been passed the coil is run down over its ends to the lips of the
wound. A perforated shot is then also passed over, and by means
of a pair of strong forceps, carried on until the coil has been
pressed low enough to tighten the suture. It is then to be
crushed and all is secure. By a simple clip of the scissors across
any part of the coil, the ends of the suture are at once set at
liberty, of sufficient length to enable the operator to bend them
back and withdraw them easily.
Dr. EoTJTH exhibited his two needles eoe vesico-vaginal
FISTULA. The ends are bent like a corkscrew li turns, but each
in opposed directions. These needle ends are fastened to a long
handle.
A BELT, to the front part of which is attached (by a ball-and-
socket joint, and a regulating screw) a catheter-holder to retain
the catheter in situ, after the operation for vesico-vaginal fistula,
in those cases where the urethra has been much injured, was
exhibited by Mr. Pratt. This ingenious arrangement is the in-
vention of Mr. Philip Habpee.
220
WOMB-SUCKER.
WOMB-SUCKER.
The WoMB-STJCKEK (Der Grebarmattersauger, Turjau d'aspira-
tion pour la matriee), of Dr. Chables Hennig, 1862, was exhi-
bited by the author.
This syringe is constructed, 1st, for sucking the tough phlegm
out of the canal of the cervix uteri when affected with leucorrhoea,
in order to clear the mucous membrane of the cervix before
using stringent drugs, and to lessen the size of the cervix when
dilated.
2nd, for sucking blood from the os uteri after scarifying it — a
sort of artificial leech. In using it, the cervix is to be taken into
the cup of one of the vulcanized india-rubber tubes, and its small
end is to be screwed into the hard-rubber or any other syringe, then
the piston of the hard-rubber syringe must be gradually pulled.
Each number of the tubes corresponds to one of the different
sizes of the portio vaginalis ; that with the glass tube is suited
for appliance in a speculum. (The small hard-rubber tube is
a surplus without reference to the aim in question.)
LIST OF EXHEBITOES.
BRITISH.
AvELiNa, Dr., 15, Howard Street, Sheffield.
Bailey, HsifET "Woodbttffe, Esq., Thetford, Norfolk.
Baenes, Dr. E., Finsbury Square, London, E.G.
Beattie, Dr. Thos. Edwaed, Dublin.
Bell and Co., Oxford Street, London, W.
Beotvk, J. B., Esq., Upper Harley Street, London, W.
Beooke, Ch., Esq., Fitzroy Square, W.
Beyant, Dr. TV., 23a, Sussex Square, Hyde Park Grardena,
London, W.
Chambees, Thomas, Esq., Sutberland Street, London, S.W.
Cooper, Mr., 26, Oxford Street, London, W.
Co?Y, Dr. C. F., 8, Nassau Place, Commercial Road East, Lon-
don, E.
CoxETEB, Mr., 23, Grafton Street East, London.
Datis, Dr. John Hall, Harley Street, Cavendish Square,
London, W.
Duncan, Dr. Matthews, Heriot Row, Edinburgh.
Dunne, F. W., Esq., Water Lane, Brixton, London, S.
DuEEOCH, Mr., 3, St. Thomas's Street, Borough, London, S.E.
Eaelb, Dr. J. LuMLEY, 92, Newhall Street, Birmingham.
Eastlake, Dr., "Welbeck Street, Cavendish Square, London, "W.
Elus, Robbbt, Esq., Sloane Street, London, S.W.
222
LIST OP EXHIBITORS.
Ferguson, Mr., 21, Griltspur Street, London, E.G.
G-ATTON, Dr., 85, Brick Lane, Spitalfields, London.
Q-iLES, Dr., Clifton Villa, Victoria Park Eoad, Hackney, London,
N.E.
G-EEENHALGH, Dr., Grrosvenor Street, Grrosvenor Square, Lon-
don, W.
Haepee, Philip, Esq., 30, Cambridge Street, ECyde Park, Lon-
don, W.
Hewitt, Dr. G-eailt, Berkeley Square, London, W.
Hicks, Dr. J. Beaxton, St. Thomas Street, Southwark, London,
S.E.
HiLLiAED, Mr., 65, Eenfield Street, Glasgow.
Hutchinson, Mr., 36, Duke Street, Shefl&eld.
Kheone and Sesemann, Messrs., 241, "Whitechapel Eoad, Lon-
don, E.
Ladd, Mr. W., Beak Street, Eegent Street, London, "W.
LococK, Sir Chas., Bart., Hertford Street, May Pair, London,
W.
Matthews, Mr. G., Portugal Street, Lincoln's Inn Pields,
London, W.C.
Matee and Meltzee, 51, Great Portland Street, London, W.
Maw and Son, 11, Aldersgate Street, London, E.C.
Meadows, Dr., 27, George Street, Hanover Square, London, W.
Meeeiman, Dr., 13, Godolphin Eoad, New Eoad, Hammersmith,
London, S.W.
MiDDLETON, Dr., Brussels.
MuEPHT, Dr. E. W., 73, Harley Street, Cavendish Square, Lon-
don, W.
Newham, S. Esq., Angel Hill, Bury St. Edmunds, Suffolk.
OoDEN, Dr., Manchester.
Oldham, Dr., Pinsbury Square, London, E.C.
LIST or EXHIBITORS.
223
Powell, Mr., 50, Neate Street, Albany Eoad, London.
Peatt, Mr., 420, Oxford Street, London, "W.
PeiestI/ET, Dr. W. 0., Hertford Street, May Pair, London, W.
Easch, Dr., 7, South Street, Pinsbury Square, London, E.G.
Eadfokd, Dr., Moor Pield, Higher Broughton, Manchester.
EiCHAKDsoN, Dr., 12, Hinde Street, Manchester Square, London,
W.
RoBBTNS, Messrs., Oxford Street, London, W.
EoBEETON, JoHK, Esq., 333, Oxford Street, Manchester.
EopEE, Alfeed GrEOEGE, Esq., 180, Shoreditch, London, N.E.
EoTTTH, Dr., Montagu Square, London, "W.
Etjssell, Mr., 58, G-eorge Street, Portman Square, London, W.
Salmon, Mr., 32, Wigmore Street, Cavendish Square, London, W.
Salt, Mr., Birmingham.
Sansom, Dr., Duncan Terrace, Islington, London, N.
Sayage, Dr., Samaritan Hospital, Edwards Street, Portman Square,
London, W.
Skinnee, Dr. T., 1, St. James' Eoad, Liverpool.
Simpson, Sir J. Y., Bart., 52, Queen Street, Edinburgh.
Smith, Dr. Ttlee, Upper Grosvenor Street, Grosvenor Square,
London, W.
Tannt, Mr., 58, North Bridge, Edinburgh.
Teaee, J. E., Esq., 47, Hans Place, London, S.W.
"Wat, Dr., Eaton Square, London, S."W.
Wells, Spencee, Esq., Upper Grosvenor Street, Grosvenor
Square, London, W.
Weiss and Son, Messrs., Strand, London, W.C.
West, Dr. Uyedale, Alford, Lincolnshire.
West, Mr. P. L., Cockspur Street, London, W.C.
WiCKEE and Blaise, Messrs., St. James's Street, London, S.W.
WoonwAEP, Dr., 22, Poregate Street, Worcester.
Young and Son, Edinburgh.
224
LIST OP EXHIBITOES.
FOREIGN.
BouJALSKT, Prof., St. Petersburg.
Beatjn, Prof., Vienna.
Breslatj, Prof, Zurich.
Chabbieee, M., 6, Eue de I'llcole de Medecine, Paris.
Chassagnt de Lyon, Charente.
Depattl, Prof, Paris.
Eabbei, Prof, Bologna.
Paye, Prof, Christiania.
G-EBMANK, Prof, Leipzig.
GiOBDANO, Prof., Turin.
Haake, Dr., Leipzig.
Habdon, M., Rue Neuve St. fitienne du Mont, Paris.
Heleeb, Dr., Leipzig.
Hennig, Prof, Leipzig.
HoBNN, Prof, Leipzig.
HowiTZ, Dr., Copenhagen.
Htjgenbebgee, Prof, St. Petersburg.
KiiNEKE, Prof, Gbttingen.
Kbassovskt, Prof, St. Petersburg.
Lazabewitoh, Prof, Charkoff, Russia.
Lazzati, Prof, Milan.
LoLLiNi, Pbebes, Bologna.
LuEB, M., 19, Rue de I'ficole de Medecine, Paric.
LuTTEB, M., Berlin.
LIST OF EXHIBITOES.
225
Mathieu, M., 28, Eue de rAncienne Comedie, Paris.
Maetin, Prof., Berlin.
Maetik, Dr. Ed., Jun., Berlin.
Mattei, Prof., Paris.
Meissnee, Dr.
Mette, M., Christiania.
MoNDOTTE, Dr., Marennes.
Nteop, Prof, Copenhagen.
EizzoLi, Prof, Bologna.
ScANZONi, Prof, Wiirzburg.
Sims, Dr. J. Maeion, New York.
Smith, — , Esq., Christiania.
Stille, M., Stockholm.
Thomas, Prof. Simon, Leydcn.
A^'eeetee, M., Paris.
15
LIST OF mSTEUMENTS .
PEESENTED TO THE SOCIETY'S MUSEUM.
7}
Abdominal Bandage foe Hj3mob-
EHAGE
» » Bigg's
„ Tettss
Aboetion Eoeceps
Blunt Hook, Eadford's
Cephaloteibe, Hennig's
„ Depaul's
Assalini's
Rizzoli'a
Ceaitiotome, ditto
„ and Tire-T^te, ditto
Ceotchet, Eadford's
Ceaniotomy Foeceps, Barnes'
„ „ Sir J. Simpson's
„ „ Hall Davis's
„ „ Churchill's
Dilating Bags, Complete Sets, Barnes'
DiLATOE, Uteeine, Thompson's
„ Hemborough's
Antique
Ueetheal, Simpson's
»
Eceaseue Wiee Eope, Hicks'
Embeyotome, Eizzoli'a
Presented hy
Prof. Giordano.
Mr. Heather Bigg.
Maw & Son.
F. W. Dunne.
Dr. Eadford.
Prof. Hennig.
Charriere.
LoUini.
Prof. Eizzoli.
Ditto.
Ditto.
Dr. Eadford.
Maw & Sou.
Ditto.
Ditto.
Ditto.
Ditto.
Khrone & Sesemann.
Ditto.
Dr. Eobins.
Maw & Son.
Ditto.
Prof. Eizzoli.
228
LIST OF INSTETJMENTS
Peeding Bottle, British
Forceps, Gayton's
„ Lazarewitch's
„ Hennig's
„ de Poclie Chassagny's
Levy's
„ Antique (2 pairs)
„ Long, Eadford's
„ Long, ditto
„ Dr. Beattie's
„ Lovati's
„ Foot (2 pairs), Eizzoli
„ Short do.
„ Long (2 blades), do.
„ „ (3 blades), do.
„ Grreenhalgh's
„ Churchill's
Pajot's
„ Grraily Hewitt's
„ Murphy's
„ Long, Sir J. Simpson's
„ Short, do.
„ Denman's
„ Uterine, Maw
Funis Eeplaceb
Ikvalid's Dbinking Glass, Cooper
Ibeigateue, Equisier's
)ck. *^]/
Presented
Mr. Cooper.
Dr. Gayton.
Dr. Barnes.
Prof. Henuig.
Dr. Chassaguy.
LaUiai
Durrock.
Dr. Eadford.
Ditto.
Dr. Beattie.
Prof. Lazzati.
Prof. Eizzoli.
Ditto.
Ditto.
Ditto.
Maw & Son.
Ditto.
Ditto.
Ditto.
Ditto.
Ditto.
Ditto.
Ditto.
Ditto.
Sir C. Locock.
Cooper.
Maw & Son.
Khrone & Sesemann.
Maw & Son.
Ditto.
Ditto.
Metbotomb, Greenhalgh's
do.
„ Eouth's
„ Sir. J. Simpson's
OvABiOTOMT Clamp, Spencer Wells Ditto.
„ Trocar Syphon, Spencer AVells, Ditto.
„ Tubular, do. Ditto.
„ „ Spring, do. Ditto.
„ „ Spring, "Weiss Ditto.
Ovum Foiicei's F. W. Dunne,
Ei/.zoli's Prof. Eizzoli.
PEESENTED TO THE SOCIETY'S MUSEUM. 229
PiEBCE Membeane, Dubois'
Pelvimeteb, Eizzoli's
Peefobator, Sir. J. Simpson's
„ Smellie's
„ Assalini's
„ Mann's
„ Eizzoli's
Pessabt Elastic
„ GrALTANIC
„ Hodges' in Metal
„ DufiSn's
„ Zwanck's
„ Inflating
PoLTPTBiTE, Aveling's
Polypus Snaee, G-raafe's
„ Forceps
ScissoBs, Uteeine, Maw's
Spectjltjm, Antique
„ Bivalve
» »
„ Trivalve
„ Duckbill.
Stethoscope (double)
Sxehtge Syphok, Higginson's
„ „ Kennedy's
„ „ Savory & Moore's
Tibe-Tetes
Presented by
J. E. Traer.
Prof. Eizzoli.
Maw & Son.
Ditto.
Lollini.
Khrone & Sesemann.
Prof. Eizzoli.
Prof. Q-iordano.
Ditto.
Mr. Eussell.
Maw & Son.
Ditto.
Ditto.
Maw & Son.
Sir C. Locock.
Maw & Son.
Ditto.
Prof Breslau.
Maw & Son.
Ditto.
Ditto.
Ditto.
Prof. Kiineke.
Maw & Son.
Ditto.
Ditto.
Lollini.
Durrock.
Prof. Eizzoli.
Ditto.
Eizzoli's
Tbivella, do.
TuxATJ d'aspieation potjb la Matbice, Prof Hennig.
Utebine Sound, Simpson's Maw & Son.
" » Sims' Ditto.
„ Stem, Intba-, Grlass and Ebonite,
Meadows' Dr. Meadows.
Vectis (2 varieties) Prof Pabri.
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